医疗保险基金监管现状和完善对策研究.pdfVIP

摘 要 近年来，我国医疗保障事业蓬勃发展，覆盖范围和保障水平不断提高，医疗 保险基金作为整个医疗保障体系的物质基础和财力保证，在整个医疗保障事业建 设中发挥着非常重要作用。然而，医保基金在发展中也暴露出一些问题，各种医 保基金被贪污、挪用、骗取的案例不时见诸报端，损害了群众对医保体系的信心， 造成了非常不良的社会影响。因此，完善对医保基金的监管有着非常重要的现实 意义。 我国的现代意义上的医疗保险制度起步较晚，又由于医保基金在营运中遵循 “现收现付”的原则，并没有太多的积累，因此一直被学术界所忽略，只是作为 社会保险基金的一部分整体研究。但是应该看到，医保基金近年来规模不断扩大， 在国计民生中发挥的作用也越来越大，且其自身的运营管理有不同于养老保险基 金等社保基金的特点，为实现对医保基金的有效监管，保障医保基金安全，将其 作为一个独立的部分加以研究非常必要。 本文主要包括五个部分。首先在文章开头的绪论部分，对本文的研究背景、 研究意义、研究现状、研究内容和方法等进行了交待，以期能使读者能对本文有 一个宏观的把握。其次，厘定了社会保险基金、医疗保险基金、监管体系等概念， 并回顾了公共经济学、信息不对称、监管型政府、组织结构以及行政民主等理论， 以为后文的研究提供理论支撑。接着，分析了我国医保基金现行的监管体制和存 在的问题，并介绍了德国、美国、肯尼亚等国家的监管经验和对我国的启示。在 此基础上，在文章的最后提出完善我国医保基金监管体系的几个建议：加强和完 善法制建设、适当提高统筹层次、厘清各监管主体之间的监管责任、引进公众监 督，完善披露制度以及加强医疗保险监管部门的人才建设等。 关键词：医保基金 监管现状 完善对策 ABSTRACT In recent years, Chinas medical insurance has developed rapidly, the coverage and security level has also been continuously improved. As the material basis and financial assurance, the medical insurance fund plays an important role in the whole system. However, the medical insurance fund has also exposed some problems in its development and created a very negative influence in the society. Therefore, improve the regulation of medical insurance funds has a very important practical significance. The modern sense of Chinas medical insurance system started relatively late, and because of the pay as you go principle it took, it did not have much accumulation, so it has been ignored by the academic circles. Usually it is only being studied as a part of the social insurance fund. But we should see that, in the development of Chinas medical insurance, it has shown some distinctive characteristics. In order to achieve effective regulation of the medical insurance fund and protect its safety, it is very necessary to study it as an independent