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目的:回顾上海市杨浦区2011—2012医疗保险年度部分当面审核人员的情况,初步分析其违规的原因。方法:对179例门诊当面审核人员的情况进行回顾性分析。结果:参保人因素是导致违规的主要原因(P<0.05),波立维等心脑血管病类药物是导致违规的主要药物(P<0.05)。结论:医疗保险违规问题仍较为严重,医疗保险监督和慢性非传染性疾病的防治任重而道远。
OBJECTIVE: To review the situation of some face-to-face auditors in Yangpu District, Shanghai for the 2011-2012 medical insurance year, and to analyze the reasons for the irregularities. Methods: A retrospective analysis of 179 outpatient face-to-face auditors. Results: The insured person factor was the main reason leading to the violation (P <0.05). The cardiovascular and cerebrovascular diseases such as Bolivian were the main drugs leading to the violation (P <0.05). Conclusion: The problem of noncompliance with medical insurance is still serious. Supervision of medical insurance and prevention and treatment of chronic non-communicable diseases have a long way to go.