Incorporating Insights from Japan's Health Insurance Fund Regulation into China's Framework
Wang Yuhao
Wu Yuanyi
Huang Jieying
Gu Yuqi
Wang Jialong
Lu Nana
Xu Wei
Abstract：Objective:To introduce the health insurance fund supervision model in Japan,compare the current situation of health insurance fund supervision in China,learn from experiences,and propose suggestions for improvement.Methods:By combining cases and regulatory effects,it introduces Japan's"guidance-inspection"based health insurance fund supervision model.Results:Japan's"guidance-inspection"based health insurance fund supervision model is relatively effective.Compared with China,it has a higher level of organizational hierarchy,focuses on education in its supervisory approach,clarifies the direction of patients'self-paid expences,and has a well-developed dual-way communication mechanism.Conclusion:China should establish a comprehensive health insurance fund supervision pathway,clearly define the resolution pathway for self-paid expenses caused by violations,and improve the mechanisms for negotiation and dispute resolution during the process.
Keywords：health insurance fund supervisionsupervision modelexperience learning
Publication Date：2024-11-05
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 91-96 )