A multi-dimensional comparative analysis of the transformation from hospital medical insurance audit teams to task force management model
HAO Bin
HAO Ruiping
DONG Min
LIU Huiying
Abstract：Objective:To explore the practical value of transforming the hospital's medical insurance supervision model from an audit team to a task force,and to identify the specific roles and mechanisms of this transformation in im-proving management efficiency,optimizing supervision processes,preventing medical insurance violations,and enhancing the management system.Methods:By establishing a special medical insurance working team,the original audit team of the single department of the medical insurance office was transformed into a working mode led by hospital leaders and collaborated by multiple departments.Results:Through multi-dimensional innovation and in-depth cross-depart-mental collaboration,the special medical insurance working team has made up for the professional shortcomings of the audit team,reversed the passive situation of ex-post supervision,comprehensively reshaped the medical insurance su-pervision framework and the whole process of closed-loop supervision,improved work efficiency and quality manage-ment,and reduced and eliminated some penalties for medical insurance violations.Conclusion:The study summarizes successful experiences in organizational structure design,cross-departmental collaboration mechanisms,and the appli-cation of intelligent supervision technologies,providing a replicable practical paradigm for the modern transformation of hospital medical insurance supervision systems.
Keywords：medical insurance task forcemanagement modelorganizational transformationmedical insurance au-dit teammultidimensional analysis
Publication Date：2025-07-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 553-557 )