Research On Audit Of Medical Security Funds

As a part of people’s livelihood,the construction of social security has always attracted the attention of the people and the government.Among them,the most important thing is to improve and develop the medical security system.The State Audit Administration has organized and implemented the first comprehensive audit of social security funds nationwide since 2012,and organized a two-month special audit of medical insurance funds nationwide in 2016,and a three-month audit of medical insurance funds in nine provinces in 2018.It can be found that the state and the government pay more attention to health insurance,a major issue concerning people’s livelihood.Laborers’ illness not only cannot get the funds for treatment through labor,but also exerts pressure on their life and treatment.Medical insurance can help them alleviate the pressure of sick workers to a certain extent,so as to help establish social stability,adjust income gap and reflect social fairness.It can not only balance social contradictions,but also create social literature and harmonious Atmosphere.So medical insurance is an important social mechanism to adjust social relations and social contradictions,as well as an important means to promote social civilization and progress.As an effective means for the government to supervise the medical insurance fund and the medical security system,the audit of medical insurance funds plays an important role in the country and society.On one hand,it can ensure the implementation of medical insurance funds to reach a certain extent and promote the improvement of medical insurance service quality.On the other hand,it can further test whether the relevant policies of national medical insurance are applied in practice.Firstly,this paper introduces the literature review at home and abroad.On the basis of summarizing the previous studies,it introduces the theoretical basis and related concepts of medical insurance fund audit,such as expounds the objectives and contents of medical insurance fund audit,the audit process and methods,and the status of medical insurance fund audit.Then it briefly introduces the current situation of medical insurance fund audit.Next,This study uses case analysis method,taking H province’s medical insurance fund audit case as a sample,through the specific description and analysis of the implementation process of its medical insurance fund audit,as well as a brief introduction of the funds and policies related to the medical insurance fund,so that people can have a complete and comprehensive understanding of the medical insurance fund audit.It is recognized that although remarkable achievements have been made in the construction of China’s medical security system,t there are still many unreasonable problems,such as the insufficient payment of medical insurance by some units,the over-coverage reimbursement of medical insurance expenses,the untimely adjustment of medical insurance catalogue,the slow process of grading diagnosis and treatment,and the unsatisfactory results of the "two-vote system".At the end of this paper,this paper points out the difficulties and challenges in the audit work through the case of H Province medical insurance fund audit,such as imperfect audit supervision mechanism,insufficient audit resources and audit power,lack of necessary medical insurance knowledge of auditors,backward audit technology and methods,etc.Based on the analysis of the deficiencies of medical insurance audit in China,this paper puts forward some pertinent audit suggestions on the basis of summarizing the problems,such as improving the audit supervision mechanism of medical insurance funds,strengthening the application of social audit and internal audit,training and introducing audit talents of medical insurance funds,promoting the sharing of online audit resources of medical insurance funds and the development of software and hardware of medical insurance fund audit,etc.It hopes to further improve the audit of medical insurance funds,effectively supervise and standardize the use and management of medical insurance funds,so as to explore the reform approaches that are in line with the current development path,which will promote the development and improvement of the medical insurance system,as well as the health level of residents.