Research On The Current Situation Of Medical Security Fund Supervision In Hefei ——SWOT Analysis Based On 2019-2021 Annual Data

Objective: The deepening of the aging population,the rising cost of drug inspections and the continuous occurrence of fraudulent insurance frauds threaten the safe operation of the medical security fund.This paper focuses on the basic operation status of the city’s medical insurance fund supervision and management based on the medical insurance policy and the city-level overall planning of the medical insurance fund in Hefei,in order to improve the efficiency of the use of the medical insurance fund for Hefei City,and achieve fair,moderate,high-quality and efficient medical insurance medical treatment.The goal of stable and continuous operation of services and medical insurance funds provides a certain reference basis.Methods: The main research target is Hefei City 2019-2021 medical insurance fund supervision related data,the literature review method,questionnaire survey method,and data analysis method,and the SWOT analysis method is used to summarize the current supervision status of the Hefei medical security fund and the supervision of the medical insurance fund..Results:（1）From 2019 to 2021,residents’ participation in guarantees increased the payment of funding for insurance.From 2019 to 2021,it was 4.178 billion yuan,4.514 billion yuan,and 4.836 billion yuan,respectively.The employee medical insurance fund has remained more than 4.6 billion yuan in 3 years.（2）From 2019 to 2021,the expenditure of resident medical insurance funds is on the rise every year,and the fund pool whose annual fund expenditure exceeds the overall annual financing income is in deficit.The expenditure amount and growth rate of the employee medical insurance fund are relatively moderate.As of September2021,the current balance of the fund is 1,609.64 million yuan.（3）In 2018 and 2020,Hefei City implemented the basic medical insurance policy and the city-level overall planning policy for the basic medical insurance fund respectively,and promulgated the corresponding medical insurance fund supervision rules.On the basis of the strategic background of "Healthy China" and the continuous innovation of medical insurance fund supervision methods,there is a certain gap between Hefei’s medical insurance fund supervision force and other cities.With professional knowledge in technology and other aspects,the medical insurance fund supervision service ability needs to be improved urgently.Intelligent supervision technology cannot meet the current needs of modernization of medical insurance fund supervision.The rise in the prices of medical insurance and medical services and the significant increase in basic medical insurance benefits have led to the current pressure on medical insurance funds to balance their payments.（4）Using SWOT analysis,the countermeasures for the supervision of medical insurance funds in Hefei City are obtained,mainly including SW,WO,OT,SO,ST strategies,and the core indicators include the organizational model of fund supervision,institutional mechanisms,supervision informatization,fund supervision legal process and long-term mechanism.Conclusion:（1）Hefei also faces the current situation of the long-term coexistence of the limited nature of the medical insurance fund and the demand for the improvement of mass medical insurance treatment,the continuous innovation of medical technology and the growth of fixed-point pharmaceutical institutions.One of the contradictions between a limited and three unlimited contradictions will lead to the imbalance of the income and expenditure of the Hefei medical insurance fund will exist for a long time.On the basis of the current policy,the fund operation does not fully achieve the goal of "setting and expenditure and a slight balance".（2）Hefei currently has problems such as poor service capacity,insufficient medical insurance information service capabilities,and urgently needed to improve the regulatory system.The current situation of Hefei City Medical Insurance Fund supervision and management under the analysis of SWOT has advantages,disadvantages,opportunities and challenges.The existing contradictions and problems require Hefei to supervise from the medical insurance fund supervision on the basis of the basic medical insurance policy and the city-level overall management of the medical insurance fund.The basic organizational form,legalization,informatization and credit construction of management are the starting points.Professional team construction,improve the regulatory law enforcement system,accurately implement supervision of medical insurance funds,continuously strengthen the supervision and management of medical insurance funds,and gradually realize the professionalization,rule of law,standardization,informatization and normalization of medical insurance funds.（3）Medical Insurance Fund is the basis for the operation of medical security work.The medical security department must continue to continue to develop in the scope of supervision system construction,supervision methods,and the establishment of full-time supervision teams and widening the scope of supervision to ensure the safe and sustainable operation of the medical insurance fund.