The Challenges and Countermeasures of Medical Insurance Fraud Prevention under DRG Payment in China
Journal Title: Medicine and Philosophy - Year 2024, Vol 45, Issue 24
Abstract
This study takes the diagnosis related group (DRG) payment reform as a starting point to delve into the current situation of medical insurance fraud and its prevention in China. It summarizes the main challenges in combating medical insurance fraud under DRG payment and proposes specific countermeasures and suggestions. The research indicates that challenges include the urgent need to improve the DRG payment reform and its accompanying regulatory system, potential reinforcement of medical institutions' motives for medical insurance fraud under DRG payment, delays in the legal frameworks for addressing medical insurance fraud in China, and the public's limited understanding of the reform. Recommendations include accelerating the refinement of the DRG payment reform and its accompanying regulatory system, promoting a balanced development of public welfare and the profitability of medical institutions, strengthening legal supervision and collaborative governance mechanisms for preventing medical insurance fraud, and enhancing public awareness and the penalties for medical insurance fraud.
Authors and Affiliations
Botao TIAN,Nini WEI,Xiaoke GUO,Meifeng WANG,Mingfei XU,
Keywords
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