文档介绍：摘要随着市场经济体制建设的不断深入,社会保障体系的建设与完善对市场经济健康、持续发展的重要性日益受到关注和重视。社会医疗保险体系作为社会保障体系的重要有机组成部分,经过一段时间的建设后己取得了令人瞩目的成就。但是由于社会医疗保险内在特征及医疗保险基金的特殊性,使得医疗保险基金监管存在着其他经济实体有效运行中不具有的阻碍和困难,成为一个世界性难题。目前医疗保险基金管理中的诸多缺陷和不足,必须引起医保管理机构及学术界的充分重视与研究。本论文以基本医疗保险基金的监管作为研究对象,借鉴国际上的内部控制理论与反舞弊理论,结合医保基金运作情况的深入调研和国内相关典型案例的剖析,分析我国现行医保基金监管模式的利弊,提出一些有用的监管改进措施和政策建议。本论文通过研究基本医保基金概念、制度沿革、使用原则,分析、总结医保基金运行中各方关系及其自身运作特点。在研究国外医保基金监管模式的基础上,对我国政府主导型监管模式、医疗机构主导型监管模式和政府在医疗保险基金运行中的责任分析,深入研究我国现行医保基金监管模式的利弊。在上述研究的基础上,从完善医保基金内部结构及监督和完善医保基金的外部监管两个层面提出对策建议。关键词:医疗保险基金;监管;不合理支付;审计 Abstract Along with the further going of the construction of our market ecoIlomy,the importance of theconstruction andimprovement ofsocialsecurity system andthesound and sustainable development of0111"marketeconomy has increasingly gained attention and medicalinsurancesystem,笛all important part ofOUr social securitysystem,has made amazing achievements after aperiod , the innerfeatures ofthesocialmedical insurance system and theparticularity ofmedical insurance fundmakes the oversee mechanism tothemedical insurance fund have the special barriers and difficulties,which the other economic bodies done have intheir effectiveoperation and has e a worldwide present,in the management of themedical insurancefund,there existslorsofdefects and deficiency, which should draw enough attention todoadequate research on fromboth themedical management institution and academic paper takes fundamental medical insurance fundinspection aSanobject ofstudy,UseS theinternational innercontroltheory andanti—fraudulent practices theory forreference,bines theoperation situationof medical insurance fund with theanalysis oftherelatedtypical CaSeS inChina toanalyze theadvantages anddisadvantages ofOur current medical insurance oversee pattem in order toprovide some workable oversee improvement meaSures andpolicy paper consistsof fistof allisabout theresearch on theconcept,system evolution,