Research On The Governance Of Breach Of Trust In Designated Medical Institutions In Tongshan District Of Xuzhou

In recent years,the national medical insurance system has always adhered to the people as the center,coordinated the development of epidemic prevention and control and medical insurance,promoted the medical insurance reform to deepen,promoted the quality and efficiency of management services,steadily improved the treatment of the masses,and the overall smooth operation of the system.The rising income level and health consciousness of our residents have brought the medical insurance system into thousands of households,and the number of insured persons,the number of medical institutions designated for medical insurance,and the medical insurance settlement have increased year by year,which inevitably led to the breach of trust in the use of medical insurance funds by designated medical institutions.Such a large and increasing number of insured people and medical insurance settlement,and the increasingly complex and hidden breach of trust by designated medical institutions are unprecedented challenges to the management of medical insurance funds,and active measures must be taken to vigorously and effectively prevent the breach of trust by designated medical institutions.By analogy with the characteristics of the breach of trust of designated medical institutions and the meaning of the three elements of "pressure,opportunity and excuse" of the fraud triangle theory,we found that the breach of trust of designated medical institutions is in line with the fraud triangle theory,which is consistent with the analysis idea of pressure inducing engine,opportunity as a condition and excuse to support.Therefore,based on the fraud triangle theory,it is conducive to put forward the optimization strategy to prevent and control the breach of trust of the designated medical institutions in a comprehensive and systematic way.Based on the fraud triangle theory,the current specific initiatives to prevent and control the breach of trust in in designated medical institutions are analyzed and classified into three types: controlling pressure,limiting opportunities,and suppressing excuses,taking Xuzhou Tongshan District as an example.Some specific cases dealing with breach of trust were selected and analyzed and studied in terms of the sources of case clues,specific violations,and case processing results.In the same time,some people closely related to the use of medical insurance funds were interviewed face-to-face regarding the specific situation of preventing breach of trust in designated medical institutions at the present stage.Through the above research,combined with the experience of the law enforcement officers in the law enforcement work,it was found that the following problems still exist in the governance of the breach of trust by the designated medical institutions: the intervention of the motives that induce the breach of trust by the designated medical institutions is not in place,the opportunities for the breach of trust by the designated medical institutions have not been fully controlled,and the psychological excuses for the breach of trust of the designated medical institutions have not been completely eliminated.Further analysis of the existing problems reveals that the main reasons for these problems include insufficient attention to the motives for generating breach of trust,incomplete intervention in the opportunities for committing breach of trust,and untimely intervention in the excuses for breach of trust by parties to breach of trust.Therefore,it is necessary to optimize the governance of trustworthy behavior of designated medical institutions from three aspects: relieving the pressure of institutions and eliminating the motives of breach of trust;expanding the scope of supervision and controlling the opportunities of breach of trust;and clarifying the responsibility function and abandoning the excuses of breach of trust,so as to gradually achieve the goal of ensuring the reasonable and safe operation of medical insurance funds while providing quality and inexpensive medical services to the participants.