A市医疗保险基金审计案例研究

发布时间：2018-08-20 08:25

【摘要】：随着我国近年来社会经济的发展和社会保障需求的提高,医疗保险作为社会保障的重要组成部分,其基金的规模日益庞大,如果缺乏有效监督,必将产生极大的隐患。审计监督作为维护国民经济健康、持续发展的监管手段,对于确保医保基金的安全、完整、有效运行责无旁贷。审计机关应当随着医保政策的不断更新与完善进一步加强医保基金审计的手段与方法,从而使审计人员能够更好的履行相应职责,切实保证医疗保险基金都能够得到合理、合法、有效的运用,从而达到维护广大的人民群众根本权益的最终目的。因此,对其进行审计的相关研究对于维护人民的基本权益、推动医疗保险制度的建立与完善等方面具有重要的理论与现实意义。本文在对前人的相关研究进行归纳总结的基础上,对医疗保险基金审计的相关概念、主要内容与具体目标进行介绍,阐述了医疗保险基金审计现状,并结合A市医保基金审计案例,通过对A市社保基金审计概况、医保基金审计案例的审计内容、审计过程进行介绍,对其审计工作取得的主要成效与结果进行论述,以及A市医保基金审计中存在问题进行分析,包括针对医保制度整合的有关审计监督有待完善,医保全国联网异地就医审计技术有待提升,以及医保基金审计人员的知识与技术水平有限。在本文的最后,对完善医疗保险基金审计提出了以下三个方面的建议:一是强化医保基金审计监督与预防职能;二是增强与完善计算机联网审计的应用;三是建设高素质医疗保险基金审计队伍。以推动医保基金审计的理论与实践的进一步发展与完善。
[Abstract]:With the development of social economy and the improvement of social security demand in recent years, medical insurance as an important part of social security, the scale of its fund is increasingly large, if the lack of effective supervision, will produce a great hidden danger. As a means to maintain the health and sustainable development of the national economy, audit supervision is duty-bound to ensure the safety, integrity and effective operation of the medical insurance fund. With the continuous updating and improvement of medical insurance policy, audit institutions should further strengthen the means and methods of medical insurance fund audit, so that auditors can better perform their corresponding duties and ensure that the medical insurance fund can be reasonable. Legal, effective use, thus achieving the ultimate goal of safeguarding the fundamental rights and interests of the broad masses. Therefore, the research on audit has important theoretical and practical significance in safeguarding the basic rights and interests of the people and promoting the establishment and improvement of the medical insurance system. On the basis of summarizing the related research of predecessors, this paper introduces the related concepts, main contents and specific objectives of the medical insurance fund audit, and expounds the current situation of the medical insurance fund audit. Combined with the audit cases of medical insurance fund in A city, this paper introduces the general situation of social security fund audit in A city, the audit content and audit process of the insurance fund audit case, and discusses the main results and results of the audit work. And the problems existing in the audit of medical insurance fund in City A are analyzed, including the related audit supervision on the integration of the medical insurance system to be improved, and the technology of medical audit in different places of the medical insurance network in the whole country to be improved. As well as the medical insurance fund auditor's knowledge and technical level is limited. At the end of this paper, the following three suggestions are put forward to perfect the audit of medical insurance fund: one is to strengthen the function of supervision and prevention of the audit of medical insurance fund, the other is to strengthen and perfect the application of computer network audit; Third, the construction of high-quality medical insurance fund audit team. In order to promote the further development and improvement of the theory and practice of medical insurance fund audit.
【学位授予单位】：中国财政科学研究院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F842.684;F239.4

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