Study On The Medical Insurance Funds’ Management And Internal Control Evaluation Of Public Hospital

As deep push on the new healthcare reform, Medicare insurance has developed rapidly in recent years. We’re getting closer to realize the goal of universal health care. The using of medicare insurance response to the vital interests of madicare organizations\fixed hospital and the insured on actualization of healthcare reform. But there has defectiveness in inner control of medical insurance; the unregulated actions which make medicare insurance washed away become the most difficult problem. Many experts and scholars found the root of the question lay in the special of service of medical care after their exploratory. Unsymmetrical information makes hospitals on a special position of information monopoly and makes Excessive induction to patient. In order to curb the irrational rise of medical cost and protect the rational use of medical insurance fund, the madicare organizations have adopted various policies, measures and methods to improve the medical insurance fund management and form the inner control system in hospital. Therefore, the inner control system of the medical insurance fund in hospital becomes the key in medical insurance fund supervision. The purpose is to urge hospital take measure to independent management of the trades.This paper analyses the hospital’s medical insurance management and consider the fact which influence the using of medical insurance fund by using the theory of risk management from the aging of the population, uses t price index rose, the new medical reform policy environment, high-tech development, using drug supplies, and medical ethics and other aspects. Through questionnaire survey, in-depth and extensive field investigation and other methods, it sums up the risk exists in the process of the medical insurance fund management. part of the hospital even found did not pay much attention to the medical insurance fund use, and blindly purchase medical equipment, acquiescence, irrational prescription, it directly led to the rapid growth of medical expenses, medical insurance fund payments continue to rise.In order to control the medical insurance in the hospital, making full use of synergistic effect resulting from the risk management and internal control and the principle of COSO, it systematically elaborated and introduced about the construction of evaluation system of internal control of hospital medical insurance fund principle, subject, content, methods, standards and procedures. Through the rectification and improvement of medical insurance fund management in the internal control environment, risk assessment, control activities, information and communication, internal supervision, centering on the Medicare patients from the hospital identification, to hospital cure disease, finally discharged the filing fee of the entire process, the internal control of the tentacles extend to every hospital medical insurance management service the subtle link, effectively prevent the occurrence of abuse of medical insurance fund behavior.The paper raises the risk management and internal control of the medical insurance fund to substantial consolidation theoretically on the basis of Y hospital in practice, from the fusion theory into the integration of substantial. Through risk identification and analysis of the use and management of medical insurance fund in Y hospital, take up internal control system, improve the internal control system, and strengthen information management, performance appraisal category expansion measures, to provide the powerful guarantee health insurance fund internal control for the Y hospital to implement, to ensure the satisfactory results.The main characteristics and the contribution of this paper is to use the risk management and internal control theories generated by the mutual fusion, To analyze the proper management of hospital medical insurance fund and the rational use of the medical supply side perspective. The medical insurance fund in risk of hospital as a breakthrough in the study, The implementation of a bold attempt and innovation effective monitoring of the medical insurance fund, to provide some reference significance to guide the public hospital internal control of China’s successful implementation of the medical insurance fund.Limited to my own level and condition, this article which about the evaluation of internal control and risk management of the fusion mechanism is not deep enough; and in determining the evaluation index of internal control of hospital medical insurance fund, the relevant evaluation index selection, as well as the reference standard of evaluation index is also controversial. In the future we hope to have the opportunity to conduct in-depth study of internal control evaluation index of medical insurance fund, build a more complete and accurate control of the hospital medical insurance fund evaluation system, and to be tested in practice of more hospitals.