Research On The Regulation Of Basic Medical Insurance Fund

Medical insurance fund is the "money for seeing a doctor" and "money for saving lives" of people.Therefore,Party Central Committee and the State Council have always paid close attention to the supervision of medical insurance fund.However,the illegal use of medical insurance funds by some designated medical institutions still occurs,and the fraud and insurance fraud are repeated.In some areas,the "industrial chain" of defrauding medical insurance funds even appears.In the face of the new situation,new challenges and new situations,the malpractice that the original legal system can not match the current social development is gradually exposed.This paper studie the current situation of the supervision of the basic medical insurance fund in Taiyuan,analyzes the problems existing in the supervision of the basic medical insurance fund in Taiyuan,find out the problems existing in the implementation of policies,analyzes the causes,and puts forward corresponding countermeasures accordingly.It is helpful to deepen the understanding of the current supervision situation of Taiyuan basic medical insurance fund,scientifically grasp the improvement direction of the supervision capacity of Taiyuan medical insurance fund,prevent the occurrence of fraud and insurance fraud,promote the safe and efficient operation of Taiyuan basic medical insurance fund,and improve the happiness of Taiyuan people.The research content of this paper mainly includes four parts.The first chapter expounds the basic concept of basic medical insurance fund supervision and the importance of medical insurance fund supervision,law of large numbers and information asymmetry theory as the means to study the basic medical insurance fund supervision.The second chapter introduces the existing mode of the basic medical insurance fund supervision in Taiyuan city and gives a detailed description of the municipal overall planning and multi-level co-management supervision system in Taiyuan city.The main object of regulation basis as well as handling made a statement.The third chapter analyzes the existing problems,mainly including the delay of payment difficult to effective supervision and control medical costs,regulatory power is weak,organization has not yet perfect,weak fund supervision,supervision does not reach the designated position,fund regulation method is relatively single,four aspects in advance to prevent insufficient in the fourth chapter puts forward some Suggestions of improve the medical insurance fund supervision system,there are five aspects: to increase the attention of policy makers allocation,improve the regulatory system;We will introduce practical regulatory laws as soon as possible to provide legal support for regulation.To build a multi-agent supervision system and change the concept of medical insurance supervision;We will accelerate the construction of an intelligent medical insurance regulatory system and promote the big data regulatory model.Improve the quality level of medical insurance fund supervision personnel,strengthen the linkage of departments to establish a professional medical insurance enforcement team.The fifth chapter puts forward the conclusion and prospect.This paper summarizes the conclusion of the research on the regulation of basic medical insurance fund.At the same time,the future development direction of this subject is proposed.On the medical insurance fund,on the basis of the analysis of the regulatory issues,carefully study the domestic other brother provinces and cities medical insurance fund supervision model,through in-depth analysis of the Taiyuan medical insurance fund supervision,tand learned that across the country to carry out the special action against fraud insurance fraud,against the background of Taiyuan medical security departments at all levels through the efforts,the upper and lower linkage,measures and achieved some results,but there is shortage of the status quo.At present,Taiyuan fund supervision is mainly faced with the following problems.At the present stage,the intelligent monitoring system of medical insurance in Taiyuan is in the stage of construction,promotion and application,and the data application is not perfect.Affected by the system,the existing supervisory team and personnel allocation are far from meeting the requirements of supervisory work.As for local law enforcement,it is in an awkward situation that "there are no laws to follow".At the same time,many local governments adopt agreement management in their supervision,but the agreement is difficult to cover the whole area,and the low participation of the public in combating fraud and protecting the government also leads to the difficulties in supervision.This paper proposes to increase the attention distribution of decisio n-making level and improve the supervision system of medical insuranc e.We should introduce practical supervision laws as soon as possible,p rovide legal support for supervision and hold a supervision system with multiple participants,and change the concept of medical insurance sup ervision.We will accelerate the construction of an intelligent medical in surance regulatory system and promote the big data regulatory model.C ountermeasures and Suggestions such as improving the quality level of medical insurance fund supervision personnel,strengthening the linkage of departments and establishing professional medical insurance lawen forcement team.