A Research On Outsourcing Operation Mechanism Of Consolidated Supervision Business In China Social Medical Insurance

Social Health Insurance System in China began in 1994, and Social Health Insurance system for urban workers began in 1998. After decades of continuous efforts, China has already established the social medical insurance system entire coverage. Then the most important is to enforce management and run the system smoothly. With the development of rapid economical and mix society, the burden of our medical fee expenditure became increasingly heavy. As the insurance interest agent, social security department should play its dominant rule to control medical expenses and strength the supervision of all aspects.Always, the social security sector has done much work to ensure the smooth running of the social medical insurance system. However, under the situation of quick development of insurance system and expand the registered, it is hard for us to adapt to the huge change of the new health insurance. So we put forward that we can choice the excellent organizations in the market to accomplish parts regulated business of the appointed Medical Institution. With that in mind, the subject of the research is to explore the outsourcing operation mechanism of designated medical institutions.Totally, this paper included five parts:The thesis started with introduction of the explore background, main ideas, methods, frame structure of the thesis, the main content and study contributions.The second part mainly explore the current problems of security department supervision and innovate regulatory approach of the tremendous pressure. We found that the social security department in the preparation of the current working prevalent lack of manpower, the health insurance fund balance faces tremendous pressure, policy incentives were not in place and so on. Based on that mind, we make a point that we can encourage high-quality organizations to engage social insurance management, improve system operating efficiency, and at last change the function of our government.The third part study the practice of outsourcing supervision in some foreign countries(American, British, Japan etc.). Three countries have introduced social institutions involved in health care quality control practices are reflected in the tremendous energy of social participation, on this basis, to put forward our designated medical supervision useful suggestions.The fourth chapter analyzes Wenjiang consolidated supervision business outsourcing specific cases of social security designated medical institutions. Whereby the performance evaluation system design, system including sustainability indicators, quality of service satisfaction indicators, economic indicators, efficiency indicators, and in accordance with the corresponding index design assessment methods and performance evaluation system. We also found that outsourcing work is very difficulty. In addition, the medical technical barriers increase the cost of such negotiations, information asymmetry increased supervision difficult, even in outsourcing may result in the selection of internal and so that "the abuse of power" problem.The fifth part is to devise the assess index and incentive system. This part focuses on the regulation of outsourcing mode selection, performance design constraints and performance evaluation policy recommendations incentive system. In order to maximum efficient of supervision business, we hold the mind that give attention to the professional, strength the information construction and reform the payment. At last, we suggest that government could encourage commercial companies to diversify market players.The innovation of this study is to research outsourcing from the discussion of Wenjiang District, referring the United States, Britain, and Japan to analysis operation modern selection. In addition, we think government could make a guiding rule to foster professional regulatory body engaging public service.