Research On The Management Of Employee Medical Insurance Fund In Wenzhou

Urban employee basic medical insurance is an important part of China’s medical security system.It is related to the health rights and interests of hundreds of millions of people and has been paid close attention to by the whole society.Since the State Council issued the decision on establishing the basic medical insurance system for urban employees in 1998,China’s employee medical insurance system has been continuously reformed and the scope of protection has been continuously expanded,followed by the increasing difficulty of medical insurance fund management.The level of medical insurance fund management will directly affect the safety of medical insurance fund and the "life-saving money" of the people.Therefore,it is necessary to study the management and optimization path of urban workers’ basic medical insurance fund to improve the level of fund management.The author has four years of grass-roots work experience in medical agencies,and is familiar with the work contents of basic medical insurance for employees,including policies,handling processes,Department conditions,etc.Based on the grass-roots medical insurance agencies in Wenzhou,this paper studies the management of the basic medical insurance fund for employees in Wenzhou,obtains the real data from the background through the medical insurance agency platform,and intuitively reflects the revenue and expenditure of the medical insurance fund.Through the communication with the insured people and the interview with the staff,we can understand the current situation and problems of the management of the basic medical insurance fund for urban employees in Wenzhou,and explore the direction of management optimization in the future.In recent years,the income and expenditure of Wenzhou employees’ basic medical insurance fund have increased year after year.With the changes of objective factors such as economy,population and medical technology,the growth rate of fund income and fund expenditure will change,which will put some pressure on maintaining the balance of medical insurance fund.This paper analyzes the problems existing in the management of employee medical insurance fund in Wenzhou,including the management problems brought by the external objective environment.The changes of economic growth rate and population structure will affect the income and expenditure of medical insurance fund,which puts forward a test for fund management.The management object will also bring the risk of fund management.Insufficient insurance participation of enterprises,moral hazard between doctors and patients and frequent medical treatment in other places will increase the risk of fund income and increase the difficulty of management.The main body of medical insurance fund management also has management problems.The influence of medical insurance related policies,the imperfection of fund supervision laws and regulations,the lack of personnel in fund management and the low informatization of supervision system increase the difficulty of medical insurance fund management.In view of the above problems existing in the management of employee medical insurance fund in Wenzhou,this paper puts forward the optimization of medical insurance fund revenue and expenditure management,including expanding the coverage,increasing fund revenue,strengthening information construction,improving the audit system,measuring the fund revenue and expenditure in real time,and adjusting relevant policies in time;Standardize the medical insurance behavior of the management object,including standardizing the insurance behavior of enterprises,ensuring that all insurance should be guaranteed,standardizing the medical treatment behavior of the insured,eliminating the phenomenon of insurance fraud,and standardizing the medical service behavior of designated medical institutions;The improvement of the management mode of the management department includes the introduction of talents,the optimization of the management team,the improvement of laws and regulations,the improvement of the fund supervision mechanism,the broadening of publicity channels and the improvement of publicity level.