The Basic Medical Insurance For Workers As A Whole The Outflow Of Fund Risk Survey

With the rapid development of social medical insurance, the insured population increases ceaselessly, health insurance fund dimensions expands increasingly, urban workers in the medical insurance accounts for a considerable proportion of insurance status, relatively stable, enjoy treatment high, how to do well in prevention of medical insurance for urban workers, the outflow of funds, has become an important social problem.In order to ensure the medical insurance funds can play an effective role, true to the health insurance fund for insurance money in the US, as far as possible to fund the biggest effect, countries have also introduced a series of fund management measure and regulation, however, in the actual situation of medical insurance fund, waste, fraud, embezzlement and corruption in varying degrees throughout the existence of serious damage to health insurance fund, the use effect and efficiency.Through a thorough analysis of the medical insurance policy and medical institutions of the microscopic operation,put forward to be on guard the employee medical insurance fund loss of effective means and ways.The paper analyzes the risks of medical insurance fund operation from the medical insurance fund income and expenditure,by considering some situation of medical insurance operation in Z County.The risk come mainly from insurance units evasion,moral hazard of the insurance and medical institutions,policy adjustment,and high medical costs. It suggests that we should extend coverage and increase income,boost up the Fund’s ability to resist risks,increase the intensity of fund management and penalties,avoid moral hazard of the insurance units, raise the level of medical insurance coordinate and enhance coordination capacity,strengthen policy advocacy and set penalties to prevent moral hazard insurance personnel.We also neel to improve the management and monitoring of medical insurance agencies to from an effective supervision and restraining mechanism;speed up network information system for efficient quality management。Some suggestions were proposed from accelerating the correlative reform of medical institution,strengthening the management and supervision of lisited medical institution,establishing integrity system of medical insurance,cultivating professional audit talents for medical insurance, enhancing the propaganda,enforcing the consciousness of vindicating rights and interests for insurants. In order to ensure the development of medical insurance comprehensive coordinated and sustainable.