Research On Multiple Subjects Collaborative Governance Of Medical Insurance Fund Supervision Of Designated Medical Institutions From The Perspective Of Stakeholders

The supervision of medical insurance fund is of critical institutional arrangement to safeguard the security and sustainable development of the fund,as well as the main defense line to safeguard the "money for medical treatment" and "money for life-saving".In order to deal with the increasingly concealed and complicated problems of medical insurance fraud and unreasonable medical cost increase,a cooperative regulatory pattern of multiple stakeholders has been gradually formed,from the single subject of the government to the introduction of third-party supervision and extensive participation of social forces,providing a guarantee for the transformation of institutional advantages into governance efficiency.In the process of improving the supervision mechanism,there are still problems such as weak participation willingness of multiple subjects and poor cooperation,which are not conducive to the optimal development of the supervision of medical insurance funds.Under the current policy background of attaching great importance to the safety of medical insurance funds and strengthening the supervision of medical insurance funds,the research on the supervision of medical insurance funds in designated medical institutions is of practical significance to effectively prevent and curb illegal medical expenses,improve the supervision level of medical insurance agencies,and maintain the safe and stable operation of medical insurance funds.Taking the medical insurance fund supervision of designated medical institutions in Y City as an example,this thesis adopts the expert consultation method according to the Mitchell scoring principle(power,legality and urgency),and draws the stakeholders of medical insurance fund supervision and its classification after two rounds of evaluation by 20 experts.According to the degree of association with the supervision of medical insurance fund and the degree of influence from high to low,they can be divided into definite stakeholders which including medical insurance administrative agencies,medical insurance agencies,health commission,food and drug administration bureau,public security organs,insured persons and designated medical institutions.Anticipatory stakeholders: including commercial insurance companies,discipline inspection and supervision departments,medical personnel;Potential stakeholders: including medical insurance information system technical support,public media,medical insurance association,market supervision administration,drug and consumable suppliers.On the basis of identification and classification,10 interviewees in Y City who are closely related to the supervision of medical insurance fund are selected to conduct interviews,and the conflicts of interests of multiple subjects are analyzed.The interview results reveal that certain stakeholders have strong unitary subject concept and surface synergy,anticipatory stakeholders have temporary aggregation and negative cooperation,potential stakeholders have weak participation intention and lack of continuity in the collaborative process.Based on the problems above,this thesis analyzes the root causes of interest conflicts among governance subjects from the perspective of self-interest,inadequate supervision and accountability and lack of legislation.On the basis of the analysis mentioned previously,it is proposed that in order to realize the collaborative governance of multiple stakeholders in the supervision of medical insurance funds,it is necessary to start from the three elements of common rules,information sharing and interest coordination,resolve the existing interest contradictions,and form the collaborative governance force of multiple stakeholders.