反社会医疗保险欺诈法律对策研究

发布时间：2018-10-25 16:25

【摘要】：随着社会的飞速发展,为保障被保险人接受医疗服务时的医疗卫生质量,满足广大群众患病时接受医疗服务的需求社会医疗保险应运而生。社会医疗保险是国家通过立法规定,参保人在患病的情况下,可从社会保险机构得到相应比例的治疗费用的社会保险制度。然而由于社会医疗保险欺诈这一行为的大量出现,使得社会医疗保险没有发挥其应有的作用。反社会医疗保险欺诈是维护社会医疗保险基金健康运行的重要途径,保障参保人社会保障权实现。然而我国的反社会医疗保险欺诈却在立法、执法和司法上存在不足和缺陷,严重危及社会医疗保险基金的健康运行,从而导致我国的社会医疗保险基金大量流失。因此,提出行之有效的反社会医疗保险欺诈法律对策是维护社会医疗保险基金健康运行,实现参保人社会保障权的重要手段。本文通过由浅入深的方式使用研究历史法、比较法、社会学方法等方法,先对社会医疗保险欺诈与反欺诈进行概述,列举社会医疗保险欺诈的基本情形。然后对我国反社会医疗保险法律制度的现状进行概括总结,之后以英国、美国、德国为代表,剖析社会保障制度较为完善的国家,其在反医疗保险欺诈方面的立法成就及对我国的启示。最后,根据我国的现状、特殊国情及搜集的资料提出我国反社会医疗保险欺诈的基本法律对策。
[Abstract]:With the rapid development of society, social medical insurance emerges as the times require in order to ensure the medical and health quality of the insured when receiving medical services, and to meet the needs of the broad masses of people to receive medical services when they are ill. The social medical insurance is the social insurance system which the country passes the legislation stipulation, the insured can get the corresponding proportion of the treatment expense from the social insurance institution in the case of illness. However, due to the appearance of social medical insurance fraud, social medical insurance does not play its due role. Anti-social medical insurance fraud is an important way to maintain the healthy operation of social medical insurance fund and ensure the realization of the right of social security. However, China's anti-social medical insurance fraud in legislation, law enforcement and judicial deficiencies and shortcomings, seriously endangering the healthy operation of social medical insurance funds, resulting in a large number of social medical insurance funds in China. Therefore, it is an important means to maintain the healthy operation of social medical insurance fund and realize the right of social security to put forward effective legal countermeasures against social medical insurance fraud. By using the methods of history, comparison, sociology and so on, this paper summarizes social medical insurance fraud and anti-fraud, and lists the basic situation of social medical insurance fraud. Then it summarizes the current situation of our country's anti-social medical insurance legal system, and then takes the United Kingdom, the United States and Germany as the representatives to analyze the countries with relatively perfect social security system. Its legislative achievement in anti-medical insurance fraud and its enlightenment to our country. Finally, according to the present situation of our country, the special situation and the data collected, the author puts forward the basic legal countermeasures of the anti-social medical insurance fraud in our country.
【学位授予单位】：西南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：D922.182.3;D924.3

【共引文献】