Research On The Evaluation Of Anti-fraud Effect Of Social Medical Insurance From The Perspectibe Of Collaborative Governance

With the development of the social medical security system,the problem of medical insurance fraud has gradually emerged.However,with the establishment of the National Healthcare Security Administration,the anti-fraud work of medical insurance has been carried out rapidly,and a special campaign of "Crackdown on Medical Insurance Fraud " has been launched nationwide.Medical insurance antifraud efforts have been underway for several years now,from 2018 to 2020,the National Healthcare Security Administration recovered more than 30 billion yuan of medical insurance funds,and achieved remarkable results.In this context,using certain methods to comprehensively evaluate the current medical insurance anti-fraud effect will be of great significance to the future medical insurance anti-fraud work.Based on this,this paper selected D city,E city,and F city as the sample areas in Jiangsu Province.On the basis of collaborative governance theory and risk management theory,this paper analyzed the current situation of medical insurance fraud and anti-fraud in the sample area,and mainly introduced the subject and object,measures and achievements of medical insurance anti-fraud.Based on the research of theory and practice,the evaluation index system of medical insurance anti-fraud effect was comprehensively constructed from the five dimensions of political effect,economic effect,legal effect,social effect and synergistic effect,and the final evaluation index system was obtained by using expert consultation method and analytic hierarchy process.After empirical analysis,it could be found that the current medical insurance anti-fraud work had achieved the following results: first,the effect of medical insurance anti-fraud had improved year by year;second,medical insurance anti-fraud had achieved good political and legal effects;third,the economic effect of medical insurance anti-fraud had grown rapidly;fourth,the concept of medical insurance anti-fraud synergy was initially reflected.But at the same time,there were also the following problems: first,the social effect had not been achieved ideal target;second,the awareness rate of the insured people’s laws and regulations was not high;third,the departmental linkage lacked motivation;fourth,the update of intelligent monitoring technology lagged behind the actual changes.In order to achieve more results in the medical insurance anti-fraud work in the future,the following relevant suggestions are put forward: first,improve the construction of the social credit system;second,increase the propaganda power of medical insurance anti-fraud laws and regulations;third,formulate positive incentive policies for collaborative governance;fourth,speed up the construction of medical insurance anti-fraud professionals.