Studyon Risk Management Of Medical Insurance Fund For Urban And Rural Residents In FC District

The medical insurance fund is a special fund that is collected from employers and employees according to the relevant laws,regulations and policies of the state,and is used to protect the medical insurance of the insured persons through other legal means.The medical insurance fund is an important part of the social insurance fund and plays an important role in the entire social insurance system.At present,with the healthy and sustainable development of social undertakings with Chinese characteristics,the integration of urban residents’ medical insurance and new rural cooperatives is being pushed forward,and the coverage of the basic medical insurance system is gradually expanding.The number of insured residents has covered from tens of millions of urban workers in the initial stage to nearly 1.4 billion urban and rural residents.As the level of social security continues to increase,the principle of overall balance of payments and a balance of balances has gradually been broken.In addition,under the new situation,as China’s population aging process intensifies and medical expenses continue to grow year by year,the pressure on medical insurance funds is increasing,the risks faced by medical insurance funds are increasing sharply,and the challenges facing medical insurance management are becoming more and more difficult.Therefore,under such a background,,how to strengthen the scientific management of the medical insurance fund more effectively is of great theoretical and practical significance for the balance of income and expenditure of the whole medical insurance fund and the healthy operation of the medical insurance system.This paper makes a detailed analysis of the risks of medical insurance funds by using the relevant knowledge of risk management,drawing lessons from the theory and practice of medical insurance fund management and risk management at home and abroad,combining with a large number of existing data of medical insurance funds in FC district,and according to the policies of higher departments.On the one hand,the FC District has achieved certain results in the management of medical insurance funds,which are embodied in the fact that the collection income of medical insurance funds has steadily increased,the level of protection has been continuously improved,and fund management has been continuously strengthened.On the other hand,the FC area still faces certain risks in fund management,mainly reflected in: fund raising risks,fund payment risks and fund management risks.In this regard,the main reasons for the risk are: the top-level design of the management system,the expenditure pressure of medical expenses,the lack of service capacity of primary medical institutions,and the inadequate supervision of medical insurance funds.Then,risk assessment was carried out from the fundraising,payment and management links.Finally,combined with the current situation of fundraising,payment and management of the FC District Medical Insurance Fund,and drawing on the excellent experience at home and abroad,we will increase medical care from the above identified risks,from the unified funding standards,broadening the form of payment,and increasing the collection rate.Open source of insurance funds;prevent the payment risk of medical insurance funds from the institutional reform of medical institutions and the establishment of a grading diagnosis and treatment system;from strict cost auditing,improvement of auditing system,strengthening of information construction,establishment of comprehensive supervision and improvement of staff team building,etc.In terms of strengthening the supervision of medical insurance funds,and further preventing the management risks of medical insurance funds.Thereby forming a complete and effective medical insurance fund management system,focusing on improving the efficiency of the use of medical insurance funds,ensuring the basic medical needs of the insured personnel,strictly regulating the boundaries of basic medical insurance liabilities,promoting the rational use of medical and health resources,and building the bottom line.Ensure that the medical insurance business in the FC area continues to grow healthily.