Study On Risk Control Of Medical Insurance Fund For Urban Employees In Y City

In 1998,the whole province carried out the reform of the employee medical insurance system.In 2000,Y city set up the medical insurance handling service center and began to implement the medical insurance system for urban workers.As medical insurance for urban workers is one of the main parts of the basic social security system,the risk management of medical insurance fund is directly related to the smooth operation of the whole national basic medical security system,as well as the vital interests of all walks of life staff and residents.With the deepening of the medical insurance policy,the aging of China’s population,the increase of medical treatment expenditure and other factors,strengthening the risk control of medical insurance fund is of great significance to the standardized use of medical insurance fund and the safe and stable operation of the fund.Starting from the operation data of medical insurance fund for urban employees in Y city,this paper conducts a risk control study on basic medical insurance fund for urban employees in Y City.This article first summarizes the domestic research of scholars from all walks of life for the urban medical security system,based on the urban employees’ medical security system for expansion in this paper,and discusses the issues related to risk management and the basic theory,content involves the formation of risk factors,risk control method and internal control.Second,the urban employees’ medical insurance fund for Y city running status are analyzed,including Y city town worker medical insurance development course,the constitution of the fund,and fund management approach,at the same time for Y city town worker medical insurance fund raising and settlement principle in depth,scope,way of field investigation and study.Again,with Y city urban employees’ medical insurance fund in 2016-2020,the basis of the actual operation data,by means of Y city medical insurance fund balance of payments surplus situation,a budget,ginseng protect personnel structure,rate,the medical establishment that decide a dot irregularities is investigated according to the analysis of the situation,and other important,assess influence Y city town worker medical insurance fund risks in all kinds of factors,In this way,the risks existing in the fund raising stage,settlement stage and system structure of urban workers’ medical insurance in Y city are analyzed.The main risks are as follows: insufficient collection strength of the agency;The fund support capacity of each county and district in Y city is unbalanced;Population aging;Health insurance fraud.Finally,in order to more reasonably manage the risks of urban employees’ medical insurance fund in Y city,specific management measures must be determined according to the risk factors at different stages obtained after evaluation: to further improve the proportion of employees’ medical insurance and increase the number of insured groups;Conduct regular base audit to ensure fund income;Gradually complete the maintenance and increment management of employee medical insurance fund;Implement an integrated system of industry and finance to improve the budget level of the fund;Improve the admittance and withdrawal system of designated medical institutions;Set up the adjustment fund system,further improve the risk prevention system;Accelerate and deepen the reform of the payment method of medical insurance;We will improve the policy incentive mechanism for cracking down on insurance fraud.