| 引用本文：张金穗, 胡敏, 陈文, 龚忆莼, 李建梅.我国基本医疗保险参保人信用管理内容设计的探索与启示——基于18省市信用管理政策文本的内容分析[J].中国卫生政策研究,2022,15(5):47-51 |
|
| 我国基本医疗保险参保人信用管理内容设计的探索与启示——基于18省市信用管理政策文本的内容分析 |
| 投稿时间：2022-01-07 修订日期：2022-04-11 PDF全文浏览 HTML全文浏览 |
| 张金穗1, 胡敏1, 陈文1, 龚忆莼2, 李建梅2 |
1. 复旦大学公共卫生学院 上海 200030;
2. 上海市医疗保险协会 上海 200051 |
| 摘要:目的：分析我国各地出台的涉及参保人主体的信用管理政策内容及特点，总结参保人信用行为界定范围和信用结果处理手段，为后续信用体系建设完善提供科学依据。方法：采用内容分析法，从官方网站收集2021年10月1日前出台的涉及参保人主体的信用管理政策文件，构建编码体系将政策内容归类，并统计其使用频率。结果：本文分析了符合条件的18个省市的21份信用管理政策文件，归纳出8类各地界定的参保人信用行为，包括29种具体行为以及失信惩戒和守信激励的22种具体措施。结论：在信用管理体系的初步发展阶段，我国各地医保参保人信用管理内容设计缺乏一致性，需要顶层设计进一步引导，逐步统一、完善医保参保人信用行为的界定范围，建立合理的守信激励和失信惩戒措施，从而建成管用高效的信用管理体系。 |
| 关键词:基本医疗保险 信用 信用管理 参保人 |
| 基金项目:首都医科大学国家医疗保障研究院开放性课题(YB2021B01)；上海市医疗保险协会项目(YBXH-KT202005) |
|
| Exploration and enlightenment of the content design of credit management for the basic medical insurance insured in China: Based on the content analysis of the text of credit management policy of 18 regions |
| ZHANG Jin-sui1, HU Min1, CHEN Wen1, GONG Yi-chun2, LI Jian-mei2 |
1. School of Public Health, Fudan University, Shanghai 200030, China;
2. Shanghai Medical Insurance Association, Shanghai 200051, China |
| Abstract:Objective: To analyze the contents and characteristics of credit management policies issued in various parts of China involving the main insured, summarize the definition scope of the credit behavior of the insured and the means of processing credit results, and provide a scientific basis for the improvement of the subsequent credit system construction. Methods: Using content analysis method, the credit management policy document involving the insured person's subject was issued by October 1, 2021 from the official website, the coding system was constructed to classify the policy content and count its frequency of use. Results: This paper analyzed the 21-point credit management policy documents of 18 eligible provinces and cities, and summarized the credit behavior of the insured defined in 8 categories, including 29 specific acts, as well as 22 specific measures of breach of trust punishment and trustworthiness incentive. Conclusion: In the initial stage of the development of the credit management system, the design of credit management content of health insurance insured in various parts of China lacks consistency, and it is necessary to further guide the top-level design, gradually unify and perfect the definition of credit behavior of the medical insurance insured, establish reasonable trustworthiness incentive and breach of trust disciplinary measures, so as to build a functional and efficient credit management system. |
| Key words:Basic medical insurance Credit Credit management The insured |
| 摘要点击次数: 849 全文下载次数: 539 |
|
|
|
|
|
