Social security card box

Interest-driven, poor medical insurance supervision, leading to the failure of fraudulent insurance.

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Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. However, since the establishment of the universal medical insurance system, the "fraudulent insurance" incidents in hospitals have been repeatedly banned. Among all kinds of insurance fraud, there are both vicious large-scale insurance fraud cases and "collusion between doctors and patients" caused by poor design of medical insurance system.

Why is cheating on medical insurance repeatedly prohibited? I think there are two points:

profit-driven

Now it is a society where money and interests are paramount. Many hospitals have defrauded a large number of medical insurance funds, some of which are used for infrastructure construction and payment of wages and benefits for employees, and some are for their own use.

Medical insurance supervision is weak.

According to the relevant regulations, medical insurance inspectors can only view the number of hospitalizations, days, medical records, disease expenses and so on. As for whether the medical records and expense details are unreasonable or even forged, they can't find out, which naturally gives criminals an opportunity. All medical insurance-related businesses, such as the determination of designated medical insurance institutions, daily assessment and supervision of medical insurance, and reimbursement of medical insurance funds, are concentrated in medical insurance institutions, which leads to the lack of supervision efficiency. In addition, there is a lack of inter-departmental cooperation mechanism in the supervision of hospitals and medical treatment in different places, and the punishment is not strong. Can only punish the behavior of taking medical insurance funds. Therefore, it is necessary to establish a long-term supervision mechanism for medical insurance agencies and health departments, increase punishment and restraint for illegal hospitals and medical personnel, and establish a coordination and restraint mechanism for medical units in different places.

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In short, due to rampant fraud, the state should strengthen supervision and improve the medical insurance system.