Research On Management Problems Of Utilization And Supervision Of Medical Insurance Fund

Social medical insurance relates to the international people’s livelihood, which has attracted great attention of the governments worldwide. It is a policy with mandatory safeguard measures with the aim of raising the level of public medical care. Social medical insurance plays an important role on the precondition of harmonious and stable of the society, and the important reflection of the social progress and development. With the popularization and promotion of medical insurance institution, also the general improvement of coverage, the usage and supervision issue of medical insurance fund has become focal point concern of medical security. How to improve the efficiency of medical insurance fund by controlling the irregular increase of medical expenses and strengthening the management of influencing factors of medical insurance fund expenditures has become an important issue for the medical insurance agencies at all levels,which has been paid much attentions by researchers.Although a late starting, the medical insurance system in China has developed quickly. The basic measures for medical insurance have built. However, with the developed of the medical insurance systems, it also highlights a number of issues. As operating funds the government spending on medical institutions is insufficient correspondingly, standard system of medical security has not established, regulation measures of medical insurance fund falls behind, margin of preference by the health policy is greater, or the influence of other factors, all of above have caused a series of problems, such as medical insurance fund expenditure is relatively centralized, medical fund expenditure is wasted, and so on. Specific performance in:the medical insurance fund expenditure increases, the ratio of fund balance declines, medical institutions extend blindly, hospitalization rates decrease, and soThis topic aims to analyze the influence factors of medical insurance fund and find the flaw of the system in management based on the historical data of medical insurance management institutions. We give some management suggestions for managers, which are included in the following part:.(1) Variance analysis of medical costs among the same disease at different medical institutions, or the same disease at different doctors of the same medical institution has been done. The analytical results indicate that the nonstandard diagnosis and treatment behavior is universal, thus making suggestions on the normalization for diagnosis and treatment.(2) Variance analysis of medical costs among different medical institutions, and comparative analysis of trend on hospital visits among medical institutions of different levels has been done. The analytical results indicate that patients are too concentrated in the big hospital. Suggestions are given for distributing patients in this part.(3) Analysis of health policy impact on hospital visits, referring primarily to the policy of out-patient co-ordination, level payment of standard and deductibles, analytical results indicate that health care policy is one of the important factors affecting medical insurance fund expenditure, thus making suggestions for medical insurance management institutions on putting forward decisions carefully in the process of studying the impact of medical insurance fund expenditures, and promoting the policy of out-patient co-ordination.(4) Time series forecasting of medical insurance fund expenditures, based on the historical data, aims to set the warning level for medical insurance fund expenditures, adjust health policy timely, ensure the safety of fund and realize the sustainable development of medical insurance system.(5) Difference analysis of clinic data between clinical-pathway or not, aims to study the meaning of clinical pathway on medical insurance management, provide the basis for further standardize diagnosis and treatment behavior, and discuss the method of improving the clinical pathway management.