Countermeasures For Fund Management In Medical Insurance

Fund management in medical insurance is recognized as a world-wide problem. At present, medical security in China has also been drawn greater attention. It is not only closely related with individual's illness and death, but also closely related to the security and stability of the whole society. Among the issues, management of medical funding is the most difficult one. Since 1970s, faced with rapidly rising medical costs, different countries have conducted in-depth studies about medical cost control approaches, summed up useful experience and conducted effective practices. China launched the reform of medical insurance for labors in 1998. Since then, the medical insurance system has gone into millions of households in cities and towns and it has a great effect in the resolution of "great difficulties and expenses of medical treatment" of the masses. However, because China's medical insurance system was established late, the system is not perfect. Fund management in health insurance requires us to do practical work for further review and improvement. Hence, the issue of fund management in medical insurance is the focus in this paper.This paper analyzed some data from case studies carried out in a Third-level Grade-A hospital in Changchun from the perspective of the hospital managers. First of all, the establishment and development of medical insurance system reform in our country was briefly introduced. The reform of the system is an important component of China's social security reform.The primary goal of medical insurance system reform of our country is to gradually establish a social risk pooling fund and a social medical insurance system combined together with individual medical accounts. With the increase of the numbers insured, the amount of income and expenditure for health care insurance fund increases. So there is higher demand for the fund management in health insurance. Through correlated analysis of the use of health insurance funds of our country in recent years, the paper raised problems in the management of health care insurance fund, and proposed some relevant solutions. This paper includes the following parts: Part I IntroductionThis chapter is mainly about the development process of the medical insurance in our country, and several major medical insurance management models abroad. At the same time, health insurance concepts involved were explained.Part II Respondents and Research MethodsInformation was mainly derived from the Website information of National Bureau of Statistics, and from the statistics of the payment of in-patients and out-patients in Medicare of Jilin Province, medical insurance from 2002 to 2008 and aThird-level Grade-A hospital in Changchun in recent years, as well as the medical expenses of insured patients.The information of the use of the fund of medical insurance was collected mainly through literature review, collecting data collection, data correlation analysis as well as interviews with health care professionals.Part III Results and AnalysisAnalysis of the following situations was carried out through the relevant data:(1) Basic medical insurance for urban workers in every district(2) Participation in medical insurance, industrial injury insurance, maternity insurance of the urban workers(3) Income and expenditure of the medical insurance fund and the cumulative balance of payments(4) Survey of the use of Medicare funds in Jilin Province,(5) Monthly inpatient and of the Medicare in Changchun CityPart IV DiscussionsThe main problems in the fund management of our health insurance can be seen through the relevant information and the data from Part III and they are listed as follows:(1) Imperfect system of health insurance policies and regulations, which is not conducive to standard management of medical insurance fund(2) Unreasonable use of medical insurance funds, resulting in inefficient use of Medicare funds(3) Inadequate fund management of the medical insurance and low level of social services(4) Enormous amount of medical insurance fund and highly specialized area make audit more difficult(5) Lax check and control of medical insurance fund make it difficult to supervise the use of fundPart V Suggestions and CountermeasuresSuggestions and countermeasures were put forward according to the related issues about the fund management of medical insurance:(1) Health insurance legislations should be sped up, and operable supporting policies be introduced(2) Integration of social health insurance resources and rational use of Medicare funds(3) Management of hospitals and insured should be strengthened and reasonable growth in Medicare costs be controlled(4) High-quality teams of medical insurance should be equipped(5) Supervision on the use of medical insurance funds should be strengthened and market mechanism of supervision of the health insurance funds spending be introducedWith the deepening and expansion of the reform of medical insurance system, and the increase in number of the participating in medical insurance, the size of funds of medical insurance will be gradually expanded, and sources more diversified. Effective management of the funds does not only concern with the vital interests of the majority of labors, but also concern with the smooth implementation of the reform of medical insurance system.