Research On The Optimization Of Basic Medical Insurance Fund Management From The Perspective Of Rights,Responsibilities And Benefits

Backgrounds: With the rapid development of social economy,deepening of population aging,increasing demand for medical services,and continuous improvement of people’s livelihood treatment,the stable operation of basic medical insurance fund is facing huge risks,and the management of basic medical insurance fund is also facing new challenges.The Chinese government is committed to improving the pooling level of basic medical insurance and implementing municipal pooling,which puts forward higher requirements for basic medical insurance fund management.The Decision of the CPC Central Committee on Several Major Issues concerning Upholding and Improving the Socialist System with Chinese Characteristics and Promoting the Modernization of the National Governance System and Governance Capacity adopted at the Fourth Plenary Session of the 19 th CPC Central Committee repeatedly emphasized the importance of balancing power and responsibility and made it clear that the development of medical insurance in the new era should place the power and responsibility in a prominent position.Therefore,based on the perspective of power,responsibility and profit,this study explored the optimization of medical insurance fund management under the background of municipal pooling.Objective: The promotion of basic medical insurance pooling level to the municipal level and the implementation of municipal pooling will inevitably lead to conflicts between the division of rights and responsibilities of medical insurance fund management at different levels,such as vertical city and county,and even lead to unclear rights and responsibilities between management departments at different levels and low efficiency of medical insurance management.At the horizontal level,the management of basic medical insurance fund involves the distribution of powers and responsibilities of multiple functional departments of local government,such as medical security,taxation,public security,civil affairs,etc.,which is manifested by complex cooperative relations among different management subjects at the same level.It has higher requirements for integrating various resources,mobilizing multiple management subjects of basic medical insurance fund to participate,and giving full play to multiple synergies.This paper studies the distribution of rights and responsibilities of relevant management subjects and fund operation of medical insurance funds in the process of implementing the municipal pooling of basic medical insurance,proposes countermeasures and strategies to optimize the management of basic medical insurance funds,which has an important reference for implementing the municipal pooling of basic medical insurance and exploring and promoting the provincial pooling.Method: Based on the principle of power,responsibility and interest,the theory of bureaucracy and the theory of collaborative governance,this paper clarifies the development process and current situation of basic medical insurance fund management by combing the development experience of domestic and foreign medical insurance fund management.Based on the three modes of municipal pooling,this paper comprehensively analyzes and investigates the regional economic development status and municipal pooling implementation.Municipal pooling areas with different fund management modes,such as City A,City B and City C,were selected as research objects for case analysis.Relevant data were collected by issuing preset self-assessment reports and survey scales,and statistical analysis was conducted on the operation of medical insurance funds in the case areas with EXCEL software.To understand the current situation and existing problems of basic medical insurance fund management under municipal pooling.Results: In the process of improving the pooling level of basic medical insurance,the unbalanced allocation of powers and responsibilities is mainly manifested by the adjustment of the powers and responsibilities of governments at different levels and the coordination of relevant fund management departments horizontally.Through the investigation of typical regions,the following problems exist in the management of basic medical insurance funds:(1)The number of insured people decreased slightly,and the pressure of fund income increased.Since the implementation of the new rural cooperative medical insurance system for urban residents in A,B and C,the number of urban and rural residents participating in the medical insurance has shown a declining trend.(2)The operation of medical insurance fund is at risk due to the imbalance of fund income and expenditure.The income of the medical insurance fund increased less than the expenditure.(3)There are many management subjects,and the efficiency of collaborative management still needs to be improved.An effective cooperative mechanism has not been established among the multi-party management bodies of medical insurance funds.(4)The handling agencies have multiple management and limited service capacity.(5)Frequent fraud insurance fraud,fund supervision is difficult.Conclusions: Based on the current situation of basic medical insurance fund management in typical regions,this paper further studies the problems existing in fund management from the perspective of power,responsibility and profit.The reasons are as follows:(1)the mismatch between "power and responsibility" affects the smooth operation of medical insurance fund.In the financing link of basic medical insurance,the imbalance of financing responsibility sharing and the limitation of residents’ cognition to participate in insurance are the main reasons for the unbalanced operation of medical insurance fund.(2)power-profit mismatch: there is a dilemma in municipal overall management.In the process of implementing municipal pooling,the efficiency of cooperative management of medical insurance funds is mainly limited by the cooperative mechanism of departments and the construction of handling institutions.(3)"Responsibility-profit" mismatch: it affects the efficiency of medical insurance fund management.In the process of improving the pooling level,the functional authority of medical insurance fund management departments at different levels has changed.In terms of fund supervision,there is also the problem of insufficient resource integration ability,which affects the service efficiency of medical insurance handling and the efficiency of fund supervision.Based on this,five optimization suggestions are put forward: first,to establish a diversified financing mechanism with balanced responsibilities;second,to strictly control the potential risks of the sustainable development of the fund;third,to establish a coordinated management mechanism of medical insurance fund departments;fourth,to straighten out the medical insurance handling and management system;fifth,to strengthen the fund supervision and management.