國(guó)務(wù)院辦公廳近日印發(fā)了《關(guān)于加強(qiáng)醫(yī)療保障基金使用常態(tài)化監(jiān)管的實(shí)施意見》?！兑庖姟诽岢?，要加大醫(yī)?；鸨O(jiān)管執(zhí)法力度，完善長(zhǎng)效監(jiān)管機(jī)制，加快構(gòu)建權(quán)責(zé)明晰、嚴(yán)密有力、安全規(guī)范、法治高效的醫(yī)?；鹗褂贸B(tài)化監(jiān)管體系。

An implementation guideline on furthering the regular regulation on the use of medical insurance funds has recently been released by the State Council. The guideline urged efforts to strengthen law enforcement of medical insurance funds regulation, improve the long-term regulatory mechanisms, and work faster to build a robust, safe, effective, and law-based routine regulatory system with clearly defined rights and responsibilities.

2023年6月9日，國(guó)新辦舉行加強(qiáng)醫(yī)療保障基金使用常態(tài)化監(jiān)管國(guó)務(wù)院政策例行吹風(fēng)會(huì)。（圖片來源：新華社）

【知識(shí)點(diǎn)】

醫(yī)療保障基金是人民群眾的“看病錢”、“救命錢”。加強(qiáng)醫(yī)?；鹗褂贸B(tài)化監(jiān)管，對(duì)保障醫(yī)?；鸢踩\(yùn)行、提高基金使用效率、規(guī)范醫(yī)療服務(wù)行為、減輕群眾看病就醫(yī)負(fù)擔(dān)具有重要意義。近年來，一些定點(diǎn)醫(yī)藥機(jī)構(gòu)“明目張膽”的騙保行為有所遏制，但是“跑冒滴漏”現(xiàn)象依然比較普遍，騙保手段更趨隱蔽，欺詐騙保和醫(yī)療腐敗交織在一起，監(jiān)管難度不斷加大。與此同時(shí)，異地就醫(yī)結(jié)算等改革措施的推進(jìn)和開展，對(duì)建立健全基金監(jiān)管制度和辦法提出了新要求。

針對(duì)現(xiàn)實(shí)中面臨的突出難點(diǎn)問題，《關(guān)于加強(qiáng)醫(yī)療保障基金使用常態(tài)化監(jiān)管的實(shí)施意見》提出了一系列具體舉措。此次《意見》主要有三方面特點(diǎn)：一是全面壓實(shí)各方責(zé)任，形成監(jiān)管合力。二是堅(jiān)持系統(tǒng)思維，推動(dòng)構(gòu)建全方位、多層次、立體化的基金監(jiān)管體系。三是著眼長(zhǎng)效機(jī)制建設(shè)，促進(jìn)醫(yī)保、醫(yī)療、醫(yī)藥協(xié)同發(fā)展和治理。

【重要講話】

要以零容忍態(tài)度嚴(yán)厲打擊欺詐騙保、套保或挪用貪占各類社會(huì)保障資金的違法行為，守護(hù)好人民群眾的每一分“養(yǎng)老錢”、“保命錢”和每一筆“救助款”、“慈善款”。

We must crack down on illegal conduct including insurance fraud, unlawful acquisition of insurance funds, or embezzlement of social security funds with a zero-tolerance stance, and protect every cent of money that people rely on to support them through old age or meet their basic needs and every cent of funds used for relief efforts or charitable endeavors.

——2021年2月26日，習(xí)近平在主持中共中央政治局第二十八次集體學(xué)習(xí)時(shí)的講話

【相關(guān)詞匯】

社會(huì)保險(xiǎn)基金

social security fund

醫(yī)保詐騙

medical care insurance fraud

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