| As the reform of the universal medical insurance system continues to advance,the national medical insurance system is gradually improving,medical institutions are flourishing under the guidance of national encouragement policies and the strong demand of the medical and health industry,and the number of medical insurance participants and the scale of fund are rapidly expanding under the strengthening of the public awareness of disease prevention and treatment.At the same time,insurance fraudulence activities are frequent and means are constantly escalating,and the chain,links and scenarios of medical insurance supervision are significantly lengthening,increasing and diversifying,posing a serious challenge to the government’s medical insurance supervision work.In order to effectively maintain the safety of medical insurance fund and achieve the medium and long term sustainable development of fund supervision,the central government insists on "zero tolerance" and "strict investigation and punishment" of insurance fraudulence activities that eat into medical insurance fund,and tightens the cage of medical insurance supervision system.In order to further implement the central government’s deployment and meet the growing and complex needs of local supervision of medical insurance fund,local government has started to carry out large-scale and centralized governance of medical insurance fund security and made medical insurance fund supervision the primary focus of medical insurance business management since 2016.Along with the maturity of purchasing "Medical Insurance Service Project",purchasing "Medical Insurance Supervision Service Project" has become a feasible exploration path for grassroots governments to improve the coverage and accuracy of supervision.City Z ranks among the top 100 counties in China and has a relatively sound medical security system.At the end of 2016,it took the lead in purchasing "Medical Insurance Supervision Service Project",which has gradually formed a set of "government-led,social force participation" project operation mode suitable for local characteristics and medical insurance supervision needs in five years,which is the practical implementation of government purchase services in the field of medical insurance supervision.This paper uses theoretical research and interviews to review the basic situation,development history and operation mode of the "Medical Insurance Supervision Service Project" of launched by the City Z government,and to systematically summarize the effectiveness of the project in promoting the transformation of the role of the Z Municipal Medical Insurance Department,improving the effectiveness of the allocation of supervisory resources and maintaining the high-handedness of medical insurance supervision.The research and analysis found that the local government still has four problems in the purchase of "Medical Insurance Supervision Service Project" : unclear legal status of the project undertaking body,non-standard government purchase,stagnation of the supply market,and project implementation effectiveness to be improved.The analysis revealed four reasons for the situation mentioned: the lack of supporting laws and regulations,imperfect government purchase mechanism,imperfect competition mechanism,lack of professional talents and weakened government guidance in terms of purchasing regulations,purchasing mechanism,purchasing market and purchasing subjects respectively,and proposed four feasible optimization measures: improving third-party supervision laws and regulations,establishing and improving purchase mechanism,cultivating competitive market and professional talents,and strengthening government guidance.Through this research,i hope to promote more local governments to explore the purchase of "Medical Insurance Supervision Service Project" to improve the effectiveness of medical insurance supervision,restrain the treatment and drug sales behavior,and protect the reasonable expenditure of local medical expenses. |
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