The China Health Insurance and Social Sciences Academic Press has jointly released the “Blue Book of Medical Insurance Fund Supervision: China Medical Insurance Fund Supervision and Management Development Report (2022).” This comprehensive publication provides a detailed overview of the current status, main issues, and challenges facing China’s medical insurance fund supervision, along with proposed countermeasures and suggestions.
Content and Findings
The Blue Book, which includes a general report, sub-reports, special reports, local explorations, hospital medical insurance management, and appendices, systematically reports on the state of medical insurance fund supervision in China. It notes significant improvements in the legal, institutional, and public opinion environments surrounding fund supervision. A new pattern of cross-sectoral comprehensive supervision has emerged, and the regulatory system and mechanism for “administration, discipline, and punishment” have been largely established. However, the report also highlights ongoing challenges, such as increasing pressure on fund revenues and expenditures, the rapid promotion of medical insurance payment method reforms, and the continuous upgrading of insurance fraud.
Future Directions
Looking ahead, the Blue Book emphasizes the need to continue improving the legal framework and systemic controls for fund supervision to maintain fund security through information platforms. It also notes growing concerns around excessive medical behavior, supervision of integrated medical and health service systems, organized fraud by groups, DRG payment mode supervision, long-term care insurance supervision, and other emerging issues.
NHSA’s Role and Achievements
At a press conference, the head of the fund supervision department of the National Healthcare Security Administration (NHSA) reported that since 2019, the NHSA has deployed 184 flight inspection teams to inspect 384 designated medical institutions, uncovering RMB 4.35 billion (USD 630.37 million) in funds suspected of illegal use. In collaboration with the Ministry of Public Security and the National Health Commission, 2,682 cases were uncovered in 2022, 7,261 suspects were apprehended, and RMB 1.07 billion (USD 155 million) in medical insurance funds were recovered. From 2018 to 2022, a total of 3,189 million designated medical institutions were inspected, 1.543 million were processed, RMB 77.13 billion (USD 11.17 billion) of medical insurance funds were recovered, and 245,000 typical cases were exposed.-Fineline Info & Tech
