CAJ | 학술논문

通过对云南“三无”医院骗保事件进行剖析，从骗保现象入手得出该事件的本质是权利寻租，通过对我国此类医保欺诈的行为因素进行分析，得出卫生体制不合理、付费机制存在缺陷、监管缺乏、法律缺失是引起此类医保欺诈的主要原因，并提出相应措施：制度改革，引入竞争；复合型支付方式，完善共付制；建立反欺诈机构，加强人才培养；完善管理机构，改变基金管理方式；构建法律体系；加强行业三方监督；建立社会监督评价机制。
통과대운남“삼무”의원편보사건진행부석，종편보현상입수득출해사건적본질시권리심조，통과대아국차류의보기사적행위인소진행분석，득출위생체제불합리、부비궤제존재결함、감관결핍、법률결실시인기차류의보기사적주요원인，병제출상응조시：제도개혁，인입경쟁；복합형지부방식，완선공부제；건립반기사궤구，가강인재배양；완선관리궤구，개변기금관리방식；구건법률체계；가강행업삼방감독；건립사회감독평개궤제。
This paper analyzes the incident in depth ,starting from the fraudulence phenomenon in “Three None” Hospital in Yunnan ,concludes the nature of the event is right rent-seeking .According to the analysis of behavioral factors about this kind of insurance fraud , unreasonable health system , defect payment mechanisms , lack of supervision , lack of legal provisions are the main reasons .So that appropriate measures are proposed :institutional reform ,introduce competition system ; use compound payment methods , improve co-payment system ; establish an anti-fraud agency , strengthen personnel training ;improve the management agencies ,change fund management ;build a legal system ;strengthen the tripartite regulation ;establish social supervision and evaluation system .