Research On The Risk Prevention Of Medical Insurance In Shenzhen

China promulgated the labor insurance regulations in 1951. On this basis, China gradually formed social insurance system of low wage and high subsidies, and the state pay for enterprises and employees. After 1990, the state-owned enterprises become independent, and the social medical insurance evolved into the current insurance system. At present social medical insurance include urban workers` medical insurance, urban residents` medical insurance and new rural cooperative medical insurance. The social medical insurance covered more than 95% of the population in our country. As a basic guarantee for a country, social medical insurance need to consider the more factors, and it is not for profit. At present, due to lack of experience and the accumulation of data, there is little analysis of risk factors on the medical insurance of our country, and then it resulted in a lack of specific period of the specific medical insurance risk control method, and can not guarantee the rational use of medical insurance fund, to provide better medical treatment security for the people in our country.The author has many years of work experience in Shenzhen social health insurance system. Based on comprehension of the social medical insurance`s introduction, insurance system the scope, and the risk prevention related theory, firstly the paper analyzed the status of social health insurance risk management in shenzhen, and then points out three existing problems in Shenzhen, including incomplete risk perception, lacking of effective risk assessment system, inadequate risk prevention. Secondly, based on the problems in Shenzhen`s social health insurance, the paper identified the risk of social medical insurance, including health care system risk, economic risk, social risk, payment risk, natural risk, management risk, moral risk, lack of supervision risk. It includes eight kinds of risk and 14 points. Thirdly, based on the risk points, the paper conducted index system construction and determined the weigh using AHP. The more important risk points are health care system risk, moral risk, management risk, and lack of supervision risk. And then the paper established the early warning mechanisms, evaluated the current Shenzhen`s social medical insurance risk lever using fuzzy comprehensive evaluation method. The result show that the current risk in Shenzhen`s health insurance is at a medium level of risk, and close higher lever. In particular, health care system risk is in uncontrollable. Finally, the paper puts forward the risk prevention and control measures to reduce risk in Shenzhen`s health insurance, including strengthening the policy and law, advancing the reform of medical system, strengthening management and auditing, accelerating the construction of information, enhancing people’s health awareness etc..