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医疗保险运作中的监督工作,是维持医疗保险基金平衡,实现医疗保险制度长期稳健运行和可持续发展的关键。社会保险机构作为卫生服务的第三方,要同时监督医疗服务供方和需方的行为,为了保证医疗服务的有效利用和医疗保险基金的收支平衡,就必须建立一套科学的监督机制。本文着重探讨在新的医疗保险制度下,社会保险部门如何建立对医疗服务的监督体系,以及该监督体系在实际工作中的作用与意义。
Supervision in the operation of medical insurance is the key to maintain the balance of the medical insurance fund and realize the long-term stable operation and sustainable development of the medical insurance system. As a third party of health service, social insurance agencies should supervise the behaviors of providers and demanders simultaneously. In order to ensure the effective utilization of medical services and the balance of payments of medical insurance funds, a scientific supervision mechanism must be established. This article focuses on how the social insurance department sets up a system of supervision over medical services under the new medical insurance system and the role and significance of this system in practical work.