Research On Intelligent Supervision Of Medical Insurance Fund In Wuxi

The medical insurance fund is the people’s "life saving money",every cent is extremely important,every expenditure should be spent on the edge of the knife.However,due to the current medical insurance laws and regulations are not perfect,the medical insurance fund supervision means are backward,the cross department cooperation mechanism is not perfect and other factors,leading to a variety of fraud medical insurance fund means,seriously affecting the safety of the medical insurance fund All.The outbreak of novel coronavirus pneumonia in 2020 disrupted the traditional medical insurance on-site inspection rhythm,which forced the medical insurance department to innovate its supervision mode and achieve intelligent supervision.Therefore,the Party Central Committee and the State Council have made a series of arrangements for the intelligent supervision of medical insurance funds,and proposed to use big data of medical insurance to boost and strengthen the intelligent supervision of medical insurance funds.Consequently,it is of important practical significance to research the intelligent supervision of medical insurance fund.In this paper,Wuxi medical insurance fund intelligent supervision as the research object,comprehensively uses moral hazard theory,cybernetics and other public management theory,using literature analysis,policy analysis,key person interview,case analysis and other research methods.Through the analysis of the development process,important measures and achievements of Wuxi medical insurance fund intelligent supervision,it is found that there are some problems in the intelligent supervision of Wuxi medical insurance fund,such as the unsound foundation of intelligent supervision data,the imperfection of intelligent supervision information system,the unscientific process of intelligent supervision,and the insufficient power of intelligent supervision and management.The reasons for these problems are the lack of top-level design,"information isolated island" phenomenon,insufficient attention,lack of professional personnel and other factors.Based on the interviews with the managers of Wuxi medical insurance fund supervision department,some designated hospitals and retail pharmacy staff,this paper studies and analyzes typical cases of intelligent supervision in Wuxi.Based on the advanced practices of Jinan,Xuzhou and Taizhou,this paper puts forward the countermeasures to strengthen the intelligent supervision of medical insurance fund in Wuxi.On this basis,the countermeasures to strengthen the intelligent supervision of Wuxi medical insurance fund are put forward: First,to strengthen the basic data of medical insurance,mainly to expand the source of basic data and improve the quality of basic data;Second,to promote the construction of intelligent supervision system,mainly from refining the system supervision rules and improving the ability of data analysis;Third,to improve the intelligent supervision process,which can be improved from the establishment of online operation process and the establishment of mutual restriction mechanism;Fourth,to increase the allocation of supervision personnel,mainly to establish a full-time fund supervision team,mobilize the third-party forces to participate in the supervision,and improve the professional level of supervision personnel.