摘要
随着医疗保险制度改革的深入,经办管理面临着越来越多的风险,影响基金的有效支付、制度的健全和可持续发展。构建医疗保险基金支付风险管理评估和预警体系的重要性和紧迫性突显出来。本文重点在政策目标、经营环境、基金任务和合理控制费用等方面,对基金面临的风险进行系统分析,运用风险管理理论与方法研究,对经办管理中的基金风险内涵及过程进行梳理,并构建基金风险预警体系。
With China＇s medical insurance system reform deeply, medical insurance system will gradually face greater risks, thus influence effective of fund spending and the sustainable development of medical insurance institutions. This paper will be based on the practice of medical insurance system, policy target, operating environment, reasonable cost control task, to try and through the application of risk management theory and methods, analysis and review of the medical insurance fund pays risk management connotation and processes, construct the fund risk early warning system, so as to improve the medical insurance system and the management system of the fund pays risk management level, ensure the healthy and stable system of medical insurance system of sustainable development.
出处
《中国医疗保险》
2012年第6期17-20,共4页
China Health Insurance
基金
2011年度国家社会科学基金重大项目(项目批准号:11&ZD176)<中国医疗支付制度系统性改革规范化研究>课题资助
关键词
医疗保险
基金支付风险
评价指标体系
预警体系
medical insurance, risk management of medical payment, evaluation index system, prewarning system of risk management
