英国NHS反欺诈治理的实践经验与启示OA

The security of public medical funds is an important foundation for the sustainable operation of the medical security sys-tem.Since the late 1990s,the British NHS has gradually established an anti-fraud governance system supported by specialized institu-tions,legal rules,digital technology and integrity culture.On the basis of distinguishing the institutional differences between the British NHS and China's medical insurance fund,the NHS anti-fraud governance experience were reviewed from four dimensions of organiza-tional system,legal system,technology application and cultural construction.The study found that the effectiveness of NHS anti-fraud governance depended on the coordination of specialized organization,standardized rules,digital supervision and integrity culture.China should strengthen the specialization and coordination of medical insurance anti-fraud supervision within the existing regulatory frame-work,improve classified regulation and liability linkage,promote data-driven intelligent supervision,strengthen integrity compliance governance,and transform anti-fraud governance from phased rectification to long-term governance.