The Fund Risk Measurement And Management Of The New Rural Cooperative Medical System

[Purpose] Based on the theory of risk management, this paper systematically analyzes the fund management mode and operation mechanism of China’s New Cooperative Medical Scheme (NCMS) fund management principles and difficulties, especially in Hubei province. Through the analysis of the system of fund risk management elements, constructing the new rural cooperative fund risk identification index system. By using the index system, We evaluate and predict the financial risk and risk management system of Hubei Province’s NCMS fund, and explore the risk factors influencing reasons, put forward the NCMS fund risk management strategy. In order to ensure the safe and stable operation of the new rural cooperative fund, the research provides theoretical and statistic evidence for enhancing the sustainable development of the NCMS system.[Methods](1) Document Analysis:Consulting the literatures of health insurance, risk management and China’s medical insurance laws, regulations and policy documents, construct the NCMS fund risk identification index system and define the new rural cooperative fund risk metrics.(2) Evaluation Entropy Method:Weighting NCMS five key indicators with entropy weight method, coculating five indicators of all NCMS regional score normalized by multiplying its weight and summing give a comprehensive evaluation of overall scores for each area, the comprehensive evaluation of the sort that can compare scores overall ranking over the Hubei NCMS running.(3) SWOT analysis method:analysizing the NCMS fund risk management strengths, weaknesses, opportunities and challenges for system analysis, put forward the corresponding strategies for the construction of NCMS risk identification index system.(4) Expert consultation and AHP:consultating the NCMS expert, Make structure and evulating of the indicators index by the importance, sensitivity, operation.With AHP determine the index weight and eventually establish the NCMS fund risk identification index system(5) Linear interpolation method, curve fitting method, Bp neural network and actuarial method:predicting the NCMS fund risk with the main financial risk indicators by appropriate methods according to the data characteristics.(6) The accident tree analysis:Make a qualitative and quantitative analysis, with NCMS risk management and the accident tree analysis method in eight research areas by its related illegal to define the NCMS fund management system defects.[Results](1) With the literature review, expert consultation and theoretical analysis, we established the NCMS fund risk identification index system and determined the NCMS fund risk including two categories of financial risk and system management The financial risk is measured by the fund usage. Drawing on the policy document, we established the NCMS financial risk decision standard of the 4 types of NCMS.(2) NCMS could strengthen the safe operation of the fund through the separation of the organization of income and expenditure, the closed operation mechanism, as well as a series of laws, policies and regulations and a variety of regulatory channels.(3) The NCMS fund in Hubei Province is overall balance of expenditure and revenue. However, the funds in various areas are not balanced. The useage of fund fluctuated frequently.(4) Participation number, per person funding, hospitalization rate and average hospitalization expenses, compensation ratio, outside the county treatment rate is the important risk indicators of NCMS fund financial, affecting the fund’s revenue and expenditure. In financing structure, financial subsidies:individual contributions to 4.2:1. The hospitalization rate is the most important factor influencing the total expenditure fund.(5) The proportion of township hospitals and hospital compensation funds decreased year by year. The proportion of hospital funds accounted for Outpatient co-ordination in the implementation of the total amount of prepaid service utilization and the average cost of the cases are stable.(6) linear interpolation method is used to predict the number of participating; logarithmic rate of hospitalization; linear regression and GM (1,1) estimated average hospitalization expenses; BP neural network to predict the fund utilization rate of error is small. Based on the balance of payments, using actuarial methods, combined with the predictive results of the participation of the population, average hospitalization expenses and hospitalization rate, we predict that the new rural cooperative medical financing should be 1229 yuan per capita at least by 2020 in Hubei Province. However, the county finances could not bear it then.(7) The illegal behavior of the NCMS is related to the fund collection, storage, use, payment and so on. Reinsurance occurred mostly.[Conclusions](1) The NCMS is designed to ensure the safety of the fund, but the actual operation of the fund is still lagging behind, weak of supervision, the positioning of the agency is not conducive to the safety of the fund management issues.(2) The NCMS fund management in Hubei province is still based on experience management, lacking of scientific fund risk prediction and control measures.(3) Financial risks of The NCMS include depending too much on the financial assistance, uncontrolled hospitalization rate growth, failed to achieve the reform goals to strengthening the primary level of the health care system, and the insufficient resources of the Management Office of NCMS and so on.(4) To ensure the sustainable of the NCMS, effective control the rise of the medical expenses is the most important.(5) The sick information system, weak foundations of the management for village clinics, shortage of personnel of the Management Office of the NCMS and lack of finance supervision system are the major causes of the violations of the management system of NCMS.(6) We should strengthen the fund risk management of the NCMS through the internal and external risk control strategies.[Innovation and Deficiency](1) InnovationIn theory, the risk of the NCMS fund is defined and classified. Define the difference standard between the the two major administrative departments of the basic medical insurance funds. Define the appropriate NCMS fund financial risk assessment criteria from the NCMS fund financing model, national policy guidance and other aspects ofIn methods, comprehensive use of a variety of methods for the NCMS fund financial risk indicators forecast The methods of application with different data characteristics are clarified. In view of the fund utilization rate, the Bp neural network is used to construct a better prediction model, which can overcome the non-linear correlation between the fund utilization rate and the influencing factors. Provideing a method for the research of NCMS which is affected by the reform measures, the complex and uncertain relationship between the variables of the forecast(2) LimitationLimited by the objective conditions, experimental intervention study cannot be done in the typical areas with NCMS fund financial. In addition, because the research object is limited to Hubei Province, the national promotion of the research conclusion still needs to be further verified.