Research On The Supervision Of Illegal Transactions Of Medical Insurance Funds Outside The Hospital

As the material basis and economic support of medical insurance system,medical security fund is a strong backing for the vigorous development of medical and health undertakings in China.The sustainable operation and development of medical security fund is related to the vital interests of all the insured.Under the current new situation,it is the primary goal of the current medical insurance work to take appropriate and reasonable measures and means to supervise the whole process of the operation of the medical insurance fund and safeguard the legitimate interests of the insured,so as to continuously and effectively provide more advanced and broader medical security services.The focus of risk management and control in the use of medical insurance funds is mainly on the rationality and legitimacy of the use of medical insurance funds by designated medical institutions.In fact,personal account is also an important part of medical insurance fund.At present,compared with the risk control of health insurance fund as a whole,the risk control of individual account is in a state of serious lack of supervision.Through the methods of interview,case study and comparative analysis,this paper summarizes the importance and urgency of the supervision of medical insurance fund at the macro level.In the part of literature review,this paper summarizes some theories and experiences of domestic and foreign experts and scholars on the risk supervision of the use of medical security funds,takes information asymmetry theory,supervision theory and Behavior Anomie theory as the theoretical support of this study.The specific roots of the problems lie in unclear responsibility orientation,backward means,lack of policy publicity,interest driven,and imperfect incentive mechanism of rewards and punishments.Combined with the current medical insurance regulatory experience in Beijing Shan ghai,Quanzhou and other places,this paper compares them with the regulatory system and framework of the German medical insurance industry,analyzes and compares the advantages and disadvantages of each policy system and regulatory structure.As to the cause of these problems,some suggestions are put forward,such as the Five kinds of countermeasures including clarifying the regulatory responsibilities of the medical insurance fund institutions,improving the regulatory capacity of the medical insurance fund institutions,and expanding the medical insurance base,in order to improve the supervision system of medical insurance fund,reduce the risk of medical insurance fund,and build a long-term mechanism for the sustainable development of medical insurance fund.