The Study On The Fraud Of New Rural Cooperative Medical Insurance From The Perspective Of Payment Mode Of The Fund

As being a significant part of our social medical insurance and social securitysystem, the New Rural Cooperative Medical Insurance (Abbr: NRCMI) plays a greatrole in easing the problem “getting proper medical care is difficult and expensive”,bettering the situation of “being financially difficult or backing to poverty as a resultof disease”, developing a basic role of the basic medical insurance. Along with Pilot,develop ment and populariz ation for nearly ten years, NRCMI has realized its term goalof all standing up to now, and the participation rate adds close up to100%. However,with its rapid development, various frauds towards the fund of NRCMI are ratherprominent, and the loss is serious. Therefore, how to guarantee the fund which is“life-saving money” in the eyes of farmers is particularly important.The scheme itself can not be ignored while studying fraud problems. This paperstrives to analyze the impact and force of different payment mode on fund fraud withthe angel of view of the payment mode of the NRCM fund. After applying thecost-income-profit of economics discussing the inner mechanism between paymentmode and fraud, and having a comparative analysis for the advantages anddisadvantages of four different payment modes on fraud protection, this paper finallyarrives at a conclusion: the Fee for services is likely to induce moral risk and induceddemand from medical institutions; the phenomenon of increasing the number ofparticipants through repeatedly and different regions attached is popular in the Captionmode; medical institution or doctor-patient conspiracy have large operating space indisease classification level in the Drgs mode; the Global budget can designedly controlmedical cost with the established budget and transfer the risk of fraud to medicalinstitutions, as s conclusion, its is relatively optimal payment mode.Combined with the NRCMI’s reality environment, this paper puts forward fiveanti-fraud measures on the base of the above research: speed up the payment modeturning to the Global budget; implement the market competition mechanism of medicalinstitution; establish the negotiation mechanism for the numerical value of the Globalbudget; normalization of the process of claim for reimbursement s; and improve thesupport of modern information technology for the NRCMI.