Evaluating Medical Insurance Fraud Policies in China
Author Information
Author(s): Zhang Zixiao, Ding Shaoqun, Yang Zitao, Hu Huaxia
Primary Institution: Southwestern University of Finance and Economics, Chengdu, Sichuan, China
Hypothesis
How effective are the current policies in preventing medical insurance fraud in China?
Conclusion
The study found that while some policies are acceptable, there is significant room for improvement in the overall effectiveness of medical insurance fraud supervision in China.
Supporting Evidence
- The average PMC index of the 18 policies was found to be 4.98, indicating general acceptability.
- Frequent medical insurance fraud is attributed to institutional endowments and information asymmetry.
- Policy evaluation revealed deficiencies in policy fields, supervision chains, and tools.
Takeaway
This study looked at 180 cases of medical insurance fraud in China and evaluated 18 policies to see how well they work. It found that many policies need to be better to stop fraud.
Methodology
The study used grounded theory and the PMC index model to analyze cases of medical insurance fraud and evaluate related policies.
Potential Biases
Potential biases may arise from the selection of cases and policies evaluated.
Limitations
The study primarily focused on policies from 2018 to 2023 and may not capture all relevant factors influencing medical insurance fraud.
Participant Demographics
The study analyzed cases from various medical institutions and involved multiple stakeholders in the healthcare system.
Digital Object Identifier (DOI)
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