Study On Internal Control Optimization Of Medical Insurance Funds In Medical Insurance Bureau Of Z District

Medical insurance fund is not only the "lifeline money" of the masses,but also the most fundamental guarantee for the masses to have access to medical services.The safety management of medical insurance fund is of great significance to the healthy operation and coordinated development of insured persons,agencies and the country.With the development of social security,the accumulation of medical insurance fund continues to increase.Because each link of medical insurance fund management appears: Weak internal control environment,health care,medical insurance fund fund organization of business risk assessment system is not perfect,internal control activities is not standard medical insurance fund,medical insurance fund information and communication mechanism is not sound internal control,internal control regulation does not reach the designated position,the medical insurance fund for medical insurance fund is embezzlement,fraud risk can not get effective control,the safety of the medical insurance fund has received the serious threat,therefore,it reflects the society insurance agency organization of medical insurance fund management to improve the internal control construction,health care agencies should establish and improve the medical insurance fund of the organization of business internal control management system,improve fund use efficiency,guarantee the safety of the medical insurance fund.The state also attaches great importance to the social security fund,and has issued a series of laws and regulations to ensure the security of the social security fund.Along with the social insurance fund,financial system,"social insurance fund accounting system","social insurance audit methods and other administrative rules and regulations of the implementation,organization of social insurance agency is to improve the compliance of the fund in accordance with the financial system track,until the department in 2007 issued by the society insurance agency organization interim measures for the internal control,the regulation of the social security fund management,internal control and construction and the social security fund as its handling of risk management on the construction of internal control of important evaluation standard,This also urges all levels of social security agencies to strengthen the establishment of a sound social security fund business management internal control system.In October 2010,China promulgated the "social insurance law",the purpose is to encourage everyone to take an active part in social insurance,ask organization of social security agency to protect the operation of the social insurance fund security and protect workers’ legal rightsand interests are not violated,the law on social insurance funds internal control are also put forward the corresponding requirements,demands of social insurance funds must be special fund is special,any organization or individual may occupy or misappropriate.Based on the COSO internal control overall framework,such as control theory,contingency theory and the "interim measures for the internal control of organization of social insurance agency" and "social insurance law" and other relevant laws and regulations as the basis,using the method of literature research and case analysis,on the basis of existing research literature,through the Z district health bureau several months of internship,get the data,a comprehensive understanding of the internal control status qua of the research object.Starting from two aspects of theory and practice,in the full understanding of the Z district medical insurance fund under the premise of the current situation of internal control,through the research of the medical insurance fund raise organization of the process of business management,health care expenses and medical insurance funds payment management three link,found that health care industry in the process of the internal control problems and these problems were analyzed,and find out the deep level reasons,proposed to circumvent the optimized plan for the internal control risk and safeguard measures in order to alleviate the pressure of the medical insurance fund operation,improve the internal control system of medical insurance fund management,to ensure that the medical insurance fund management more standardized,more efficient operation.