中国医疗保障基金监督管理发展报告（2022）
书 名： 中国医疗保障基金监督管理发展报告（2022）
英 文 名： REPORT ON DEVELOPMENT OF THE SUPERVISION AND MANAGEMENT OF CHINA’S HEALTHCARE SECURITY FUND （2022）
作 者： 《中国医疗保险》杂志社 应亚珍 郝春鹏 马迎花 张琳 明延飞
I S B N： 978-7-5228-1101-7
丛 书 名：
医保基金监管蓝皮书
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关 键 词： 医疗保险 基金管理 监督管理
出版日期： 2022-12-01
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中文摘要
该书是“医保基金监管蓝皮书”系列的第二册，以“建设更高水平的法治医保”为主题，围绕“加快推进医疗保障基金监管制度体系改革”进行谋篇布局，共设置总报告、分报告、专题报告、地方探索、医院医保管理和附录6个部分。全面、系统、深入地报告了我国医保基金监管法治建设、制度建设、机制建设、队伍建设、能力建设等方面的工作现状、存在的主要问题与挑战，并据此提出应对策略及建议。
“总报告”作为本书的核心及统领，全面介绍了2021年医保基金监管工作所取得的进展和成效，从目前的形势来看，基金监管的法治环境、制度环境、舆论环境、社会氛围等都得到很大提升，跨部门综合监管新格局初步形成，具有中国特色的“行、纪、刑”三位一体的监管体制机制基本建成。“总报告”还系统地总结了全国各地在工作实践中所积累的经验，并对新形势下基金监管面临的机遇和挑战进行了前瞻性分析和展望。
“分报告”对总报告中的重点内容进行延伸，紧紧围绕提高医保基金监管法治化规范化水平、深化医保基金监管制度保障体系改革、提升医保基金监管队伍建设与监管能力、总结推广“两试点一示范”成熟经验和打击医疗保障领域欺诈骗保专项行动5个方面做深度研判分析。
“专题报告”首次针对医保基金监管领域的痛点、难点问题，如过度医疗行为认定及监管、紧密型医疗联合体监管、团伙欺诈骗保、DRG支付方式下监管、长护险监管等，聚焦新技术应用和新工具开发，提出破解方案。
“地方探索”和“医院医保管理”从100多篇来稿中精心选出，各9篇文章。“地方探索”部分重点介绍了基层医保基金监管改革成效和创新经验，包括了省、市、县不同的层级以及不同的探索方向，体现一定的广泛性和全面性。文稿以丰富案例为支撑，实践与理论相结合，对医保基金监管工作具有较高的参考价值。“医院医保管理”从监管主体的视角，深入讨论了拥抱改革、积极应对、主动转变，做好新形势下医院医保管理的实践经验，有利于促进医疗健康事业长远发展。
最后为附录，收录了2021年医疗保障基金监管相关数据、国家医疗保障局公开通报的欺诈骗保典型案件集和医疗保障基本监管相关政策法规汇编。
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总报告
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分报告
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专题报告
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地方探索
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医院医保管理
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附录
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