医保支付资格管理制度

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管好用好处方“一支笔”(无影灯)
Ren Min Ri Bao· 2025-07-25 02:24
Group 1 - The National Medical Insurance Administration (NMIA) has intensified the regulation of medical insurance funds by holding individuals accountable for violations, marking a shift from solely punishing institutions to also targeting responsible personnel [1][2] - A case in Jiangxi Province highlighted this approach, where individuals involved in fraudulent activities were penalized with points against their medical insurance payment qualifications, indicating a more stringent accountability system [1] - The introduction of a point-based management system for medical insurance payment qualifications aims to enhance the precision and deterrent effect of regulatory measures, extending oversight to specific individuals within medical institutions [2][3] Group 2 - The regulatory framework emphasizes a balanced approach, combining education and punishment, with mechanisms in place to protect the rights of medical personnel while ensuring accountability [3] - Various provinces have implemented dynamic responsibility recognition mechanisms to ensure that accountability is accurately assigned, preventing generalized or superficial handling of violations [3] - The overarching goal is to ensure the proper and compliant use of medical insurance funds, which are critical for the health and well-being of over 1.3 billion insured individuals in the country [2][3]