The “Three-in-one” Medical Insurance Regulatory Model

Health insurance fund is the common people’s life-saving money, which is related to the vital interests of the majority of insured persons, and is related to the social stability. But in recent years,with the gradual expansion of the coverage of medical insurance, and the improvement of insured rate, many criminals hand to the health insurance fund. The means of illegal crime is becoming more and more concealed,illegal means constantly refurbished, and even the insured and medical institutions and pharmacies jointly defraud insurers, which is a serious threat to the health insurance fund security. How to manage large scale and limited balance of medical insurance fund has urgently placed in front of the health care agencies. Health insurance regulation is a worldwide subject, but through the reform of payment methods, third party supervision and enhance the ability to collect and process whole information has become the regulatory consensus of health care management. From Hangzhou City regulatory practice, this article tries to research on the contents and methods of supervision, and puts forward the countermeasures and suggestions on solving the problems encountered in the medical insurance cost supervision,that based on medical insurance regulation mode of Hangzhou City, through the establishment of reasonable compliance use fund atmosphere, enhance regulatory capacity and strengthen Medicare physician and ginseng protect personnel management, strengthening multi sectoral linkage with the third party supervision, strengthen efforts to criminal punishment and accessibility and improve the mode of payment and other aspects, making the regulation mode of medical insurance of Hangzhou city has become a model for the regulation of universal significance.