Research On Institutional Engineering Governance of Basic Medical Security Frauds

Proceedings of The 9th international conference on Management, Economics and Humanities

Year: 2019


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Research On Institutional Engineering Governance of Basic Medical Security Frauds

Yan Jin , Shaorong Sun and Oleksandra Koshevarova



The basic medical security system is an important part of the social security system. In recent years, reports on the fraud of basic medical security are often seen in the public media, and have attracted the attention of the academic circle. However, the research and analysis of basic medical insurance fraud is often one-sided or superficial. In order to effectively control health care fraud, insurance fraud behavior in this paper, for the first time the application of system engineering of Sun diagram to basic health care insurance fraud behavior, from behavior management system design theory of system engineering, using the doctor-patient collusion insurance fraud behavior punishment, for the reason of basic health care insurance fraud behavior person and system defect analysis, show the inhibition of contribution to the system of medical insurance fraud behavior, and finally, combining the experience in this field in our country, puts forward the corresponding control measures. This paper puts forward the following Suggestions: 1. A standardized legal punishment system should be formed to deal with insurance fraud in basic medical security; 2. Completely cut off the relationship between the amount of drugs and medical equipment sold by hospitals and doctors and their income in terms of system design; 3. Further clarify the coverage, fields and cost standards of basic medical insurance; 4.Improve the informatization degree of each link and process of basic medical security; 5.Strengthen the popularization and publicity of the correct use of basic medical security for the

Keywords:  basic medical security; fraudulent behaviour; collusion; institutional engineering; Sun diagram.