The Study On Outside Medical Treatment Networking Settlement For Basic Medical Insurance In Cangnan County,Zhejiang Province

Basic medical insurance is an integral part of China’s social insurance system.It is also an important guarantee system to ensure social harmony and reduce the medical burden of insured personnel.But,with the development of social & economy of China,the problem of medical treatment in different places under the existing medical insurance system has become increasingly prominent.Improvement of outside medical treatment networking settlement for basic medical insurance is an important measure to solve the problem of medical treatment in different places.Cangnan County of Zhejiang Province,as a relatively developed coastal area in Southeast China,is a large county with 1.2 million basic medical insurance insured people.A thorough study of the outside medical treatment networking settlement for basic medical insurance of Cangnan County is of typical significance for understanding the current situation of outside medical treatment networking settlement for basic medical insurance in China.Taking Cangnan County of Zhejiang Province as an example,This paper makes a thorough and systematic analysis of the network settlement of basic medical insurance insured personnel in Cangnan County in different places outside the county.This study systematically reviews the development process of Cangnan County’s outside medical Treatment networking settlement,collates and introduces the related policies of Cangnan County’s basic medical insurance outside medical networking settlement,and makes a comprehensive analysis of Cangnan County’s outsite medical networking settlement model.This paper makes a statistical analysis of the settlement data obtained from Cangnan Medical Insurance Information System.The results show that the settlement data of Cangnan County’s outsite medical networking settlement has the characteristics of large demand and centralized destination.The study found that there are many problems in the current settlement of outside medical network in this county,such as low proportion of network settlement,difficult application for referral,high failure rate of information system,different treatment of networking settlement and manual settlement,difficult to effectively supervise the behavior of outside medical treatment,and difficult to implement the reform of medical insurance.These problems bring a lot of inconvenience to the outside medical settlement of basic medical insurance personnel in Cangnan County,and also put forward new requirements for the operation of medical insurance business and the supervision of medical insurance fund.This study also analyzed the main causes of these problems in Cangnan County,and found that the low level of basic medical insurance co-ordination,the low level of medical insurance information construction and the inconsistency of basic medical insurance policy are the important institutional obstacles to the development of Cangnan County’s outside medical networking settlement.Based on the study of the current situation of Cangnan County’s outside medical networking settlement,this paper puts forward some feasible suggestions to optimize Cangnan County’s outside medical networking settlement from four aspects: improving the level of medical insurance co-ordination,unifying medical insurance policy,strengthening information construction,and improving the ability of medical insurance supervision.These suggestions have strong reference significance for other areas of our country to improve the outside medical treatment networking settlement system of basic medical insurances.