The Research Of Trans-regional Medical Billing Of The Basic Medical Insurance

With the development of China’s economy and the exaltation of people’s health awareness, our healthcare insurance business has made great progress. In practice, relevant departments have made much efforts to promote the healthcare insurance such as enacting healthcare insurance policies. Till 2010 “The Social Security Law” which containing The Basic Medical Insurance consisting of three parts of urban workers healthcare insurance, urban residents healthcare insurance and the new rural cooperative healthcare insurance has been established. The Basic Medical Insurance policies in different regions vary widely so growing population mobility has been causing trans-regional medical especially trans-regional medical billing. People who seek for cross-regional medical can’t get a relatively fair and efficient medical treatment.In addition to the introduction and conclusion, the paper is divided into five parts.The first part of this thesis is the general analysis of the trans-regional medical billing in the Basic Medical Insurance. This part pointed out the reason for trans-regional medical and describes the expanding scale of it.The second part is about the main legal issue in trans-regional medical. First, People who seek for cross-regional medical can’t get a relatively fair treatment. On the one hand, due to differences of healthcare insurance policies in different district, people may get different reimbursement ratio while using the same medical resources. On the other hand,due to the difficulty of monitoring trans-regional medical billing, the reimbursement procedures is cumbersome and inefficient which may make it difficult to be reimbursed for people who obey to law while the part which should not be reimbursed get reimbursed. Second, lacking of immediate billing system make it inefficient for trans-regional medical.The third part is about the reason of legal issues in tans-regional medical billing. First, there are much difference in each region which is caused by historical reasons and economic reasons. Second, the management system for trans-regional medical is imperfect such as lacking of immediate billing system and the management confusion.The fourth part is about the EU across-border medical experience. In terms of fairness, the EU citizens should be fair and equal treated. In terms of efficiency, standardized management, unified medical application form and "one Card" make cross-border medical billing extremely efficient for EU citizens.The fifth and also the last part is the solution for trans-regional medical billing of The Basic Medical Insurance. First, downsize trans-regional medical by balance medical resource. Second, unify health insurance policy in different region to some extent as unify policies in one province. Third, improve the management and supervision system such as establish immediate billing system and strengthen judicial supervision for insurance fraud.