Study On Risk Prevention And Control Of Basic Medical Insurance Fund For Urban And Rural Residents In Hebei Province

Medical insurance for urban and rural residents is a major livelihood project.It is an important responsibility of the government to provide basic medical insurance services for urban and rural residents.Integration of the basic medical insurance for urban residents in2016 and the new rural cooperative medical care system,establish a unified basic medical insurance system covering both urban and rural residents,urban and rural residents medical insurance system in hebei province construction and effective operation,but the medical insurance fund sustainable operation there is a big risk,needs to identify risk,in view of the risk factors,improve the risk prevention and control measures.This paper,the definition of residents’ basic medical insurance fund risk related concept combing the medical insurance fund risk prevention and control,on the basis of the theoretical basis of the residents of the municipal cities in hebei province as a whole system of basic medical insurance fund risk analysis of the status quo and outlook,and aiming at the causes of urban and rural residents basic medical insurance fund risk,a series of risk prevention and control measures are put forward.From the current situation of basic medical insurance fund for urban and rural residents in Hebei Province,the growth of medical insurance fund is weak,the growth of medical insurance expenditure is too fast,and the growth of income and expenditure is inverted.Nearly 40% of the accumulated balance of municipal medical insurance funds did not reach the policy safety line.From the perspective of development forecast,the fund security situation is not optimistic because the fund income growth is slower than the expenditure growth in most cities(more than 80%).The reasons for the risks of basic medical insurance fund for urban and rural residents include many aspects: first,the number of insured people decreases and the insurance structure is unbalanced;Second,frequent moral hazard and serious loss of medical insurance fund;Third,residents’ willingness to participate in insurance has declined,and the financing mechanism is not perfect.Not only is the financing mechanism of medical insurance fund contrary to the principle of fairness,the division of financing responsibility is not reasonable,and the policy of raising the payment standard is difficult to implement,which affects the normal growth of fund revenue;Fourth,residents’ medical demand continues to rise;Fifth,insufficient fund supervision;Sixth,the policy requirements of the medical and health reform on resident medical insurance have increased the pressure of fund operation.In view of the above risks,the prevention and control measures of the health insurance fund for urban and rural residents in Hebei province include: first,improve the willingness of residents to participate in the health insurance,stimulate the enthusiasm of residents to participate in the health insurance,improve the service capacity of the agency,improve the way of financing and payment,and improve the insurance participation rate;Second,on the basis of gradually improving the financing mechanism,scientific adjustment of the financing mechanism,and effectively protecting the needs of special groups,the reasonable division of the government and the residents of the individual financing responsibility,take practical measures to solve the residents pay the standard implementation is not in place;Third,we need to meet the needs of urban and rural residents for medical services,gradually improve the mode of medical insurance payment,improve the diagnosis and treatment level of primary medical institutions,and optimize the budget index evaluation system.Fourthly,strengthen the supervision of medical insurance fund,actively build the joint management mechanism,increase the cooperation between the supervision department and other departments,so as to avoid the moral hazard of fund,gradually improve the supervision ability of fund,and realize the intelligent and informationized supervision of fund;Fifth,we will clearly define the boundary of medical and health care expenditures and medical insurance expenditures,and effectively reduce the burden of supporting expenditures of individual medical insurance funds.