Research On The Provincial Coordination Of Guizhou Province's Employee Medical Insurance Fund From The Perspective Of Holistic Governanc

It is an important measure to realize the provincial pooling of medical insurance,which can enhance the anti-risk ability of the fund and solve the unbalanced and inadequate development of the medical security field.There are 9 different policy standards in the 9 pooling areas of Guizhou Province and great differences in the policies of the medical insurance fund in terms of the financing standard,treatment level and related support system,so there is a serious fragmentation of policies.There are several problems in promoting the implementation of provincial pooling of employee medical insurance funds: large differences in financing standards,difficult to coordinate the interests of all parties;The difference in treatment level makes it difficult to accommodate different groups;The support system is not unified,so the integration is difficult;The unclear definition of rights and responsibilities leads to the increase of moral hazard at the grassroots level.In view of the above problems,based on the analysis framework of holistic governance theory,this paper explores the action path of realizing provincial pooling of the basic medical insurance fund for urban employees in Guizhou province from three dimensions: coordination mechanism,integration mechanism and trust mechanism..Firstly,in the coordination mechanism,adopt the scientific calculation method to set the unified financing standard and treatment level.The unification of financing standard and treatment level is the key to the implementation of the provincial pooling of the unified collection and expenditure of medical insurance funds.This paper uses the insurance sub model of ILO financing model to calculate the appropriate financing standard under the provincial pooling of the urban employee medical insurance in Guizhou Province,and calculates that the enterprise financing standard is 7.0%.The financing standard conforms to the financing practice of Guizhou Province,and can achieve the balance between the benefit level of the insured and the burden of the enterprise.Under the financing standard of 7.0%,according to the balance coefficient of the rough estimation method,the appropriate treatment level of 35 treatment schemes was analyzed,and finally the three optimal treatment schemes and 12 sub-optimal treatment schemes were obtained,with large room for policy adjustment.The results showed that the social health insurance financing model(ILO financing model)and the rough estimation method were suitable for the financing and treatment of medical insurance funds under the provincial pooling.The method could provide a scientific and reliable basis for the calculation of the provincial pooling financing and treatment of basic medical insurance in Guizhou province and other provinces and cities.Secondly,in terms of integration mechanism,relevant departments of fund management and fixed point management should be integrated,as well as relevant information technologies of handling services and information systems.The concrete measures include the establishment of the fund sharing incentive mechanism between vertical levels and the fund risk response mechanism of grass-roots departments;Improving the quality of community-level medical care and medical services;Strengthen the construction of hierarchical diagnosis and treatment system;To formulate uniform business procedures for the whole province;Improving the service capacity of the community;We will explore the national Medical insurance information platform.Finally,in terms of trust mechanism,aiming at the definition of power and responsibility among coordinating bodies,we should reasonably divide the power and responsibility among provinces,cities and counties,and establish an effective incentive mechanism.In order to coordinate inter-regional risk prevention,moral hazard should be effectively restrained and performance appraisal system should be established.This paper is helpful to improve the science and robustness of provincial pooling of urban workers’ basic medical insurance fund.In addition,the holistic governance theory,which aims to solve the fragmentation problem of the system,is highly consistent with the provincial pooling of medical insurance funds,so its application to the study of the medical insurance provincial pooling field is conducive to enriching the research scope of the holistic governance theory and the theoretical system of the basic medical insurance provincial pooling.This paper can provide empirical data,theoretical basis and policy reference for Guizhou Province and other similar provinces to solve the key problems of provincial pooling of urban workers’ basic medical insurance fund.