【摘要】：隨著社會(huì)保障制度的不斷發(fā)展和完善,我國(guó)在醫(yī)療保險(xiǎn)基金政策實(shí)施范圍已經(jīng)實(shí)行了城鄉(xiāng)全覆蓋,涵蓋了針對(duì)城鎮(zhèn)職工的"城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)基金";針對(duì)城鎮(zhèn)居民的"城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)基金";針對(duì)農(nóng)村百姓的"新型農(nóng)村合作醫(yī)療基金";以及針對(duì)各種急病大病的"城鄉(xiāng)大病醫(yī)保基金,城鄉(xiāng)醫(yī)療救助基金和疾病應(yīng)急救助基金"等六種、四大類。醫(yī)�；鹈鎻V量大、涉及責(zé)任主體部門多,不僅在管理上是一個(gè)難題,在審計(jì)方面也存在諸多難點(diǎn)。當(dāng)前我國(guó)正著力建立以電子數(shù)據(jù)分析為依托,"總體分析、發(fā)現(xiàn)疑點(diǎn)、分散核查、系統(tǒng)研究"的新型審計(jì)方式開展審計(jì),這種方式在針對(duì)醫(yī)療機(jī)構(gòu)的醫(yī)�；饘徲�(jì)中尤為有效,基本能解決過去我們通過傳統(tǒng)的手工查錯(cuò)糾弊審計(jì)難以發(fā)現(xiàn)的不規(guī)范行為,促使醫(yī)療機(jī)構(gòu)收費(fèi)更加合理、醫(yī)�；鹗褂酶油该�、內(nèi)部管理更加科學(xué)規(guī)范。本文系對(duì)當(dāng)前醫(yī)療機(jī)構(gòu)的醫(yī)�；饚状鬅狳c(diǎn)問題的進(jìn)行了審計(jì)思路探析。
[Abstract]:With the continuous development and improvement of the social security system, the implementation scope of the medical insurance fund policy in our country has already implemented the urban and rural full coverage, covering the "urban workers basic medical insurance fund" for urban workers; "Urban residents basic Medical Insurance Fund" for urban residents, "New Rural Cooperative Medical Fund" for rural residents, and "New Rural Cooperative Medical Fund" for rural residents; There are six categories, four categories, such as the urban and rural medical insurance fund, the urban and rural medical aid fund and the disease emergency relief fund, which are aimed at all kinds of acute and serious diseases. Medical insurance fund is a difficult problem not only in management, but also in audit. At present, China is working hard to establish a new audit mode based on electronic data analysis, "overall analysis, discovery of doubts, decentralized verification, systematic research," which is particularly effective in the audit of health insurance funds for medical institutions. It can basically solve the irregularity behavior that we can't find through the traditional manual checking and correcting malpractice audit in the past, and make the charge of medical institution more reasonable, the use of medical insurance fund more transparent, and the internal management more scientific and standardized. This paper analyzes several hot issues of medical insurance fund audit.
【作者單位】： 江蘇省海門市審計(jì)局;
【分類號(hào)】：F842.684;R197.1;F239.4

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