Medical Fund Operation,Risk Protection Institutional Research In Guangdong Province

1 Background At present,China has basically established a universal medical insurance system,the scale of medical insurance funds has continued to expand,and medical insurance expenditures have grown rapidly.At the same time,fraudulent insurance fraud and fund waste have become increasingly prominent.Therefore,the establishment of the risk prevention and control mechanism of the medical security fund is a necessary means to improve the utilization efficiency of the medical security fund and ensure the level of medical services.On December 9,2020,the State Council passed the "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds",which is my country’s first regulation on the use of medical insurance funds.Various localities have begun exploration and research on the supervision and management of medical insurance funds and risk prevention and control.2 PurposeAccording to the existing fund risk problems in Guangdong Province,analyze the shortcomings of the current medical insurance fund risk prevention and control policies and intelligent monitoring models in our province,put forward suggestions on the construction of the medical insurance fund supervision system in our province,and improve the long-term risk prevention and control of medical insurance funds.mechanism.3 MethodsTo understand the progress of domestic and foreign medical insurance and medical insurance fund supervision through literature search,to collect medical insurance fund operation,successful experience and shortcomings in 21 cities in Guangdong Province by way of on-the-spot investigation,and to analyze the medical insurance in Guangdong Province by means of forecasting of operation time and empirical research.Fund operation.(1)literature ResearchSearch the database for literature on medical insurance fund supervision,fund risk prevention and control,and medical expense control,and learn the concepts and methods of basic medical insurance fund supervision.According to the theoretical basis that has been mastered,determine the research plan,discuss and improve the research method,design the data collection table,etc.,and finally form a research plan for field investigation and data analysis.(2)time series researchA time series is a set of sequences arranged by an indicator according to the time sequence of occurrence.On this basis,predictive analysis is carried out,and the operation of the medical insurance fund is analyzed.This article uses the ARIMA model,which consists of an autoregressive model and a moving average model.The autoregressive model describes the direct relationship between the current value and the historical value,and uses the historical value of the variable to predict its own data;the moving average model means that the current sequence has nothing to do with the historical value,and only relies on the linear combination of historical white noise.The order p is the period of the historical value used when predicting the current value,q is the order of the average movement,c is the constant term,and d is the order of the data difference.(3)Field ResearchField research is a generalized empirical research method,which refers to all empirical research methods.In terms of research methods,it is a specific analysis of specific problems,and in terms of research conclusions,it is only the accumulation of experience.Through on-the-spot research and interviews,we collected policy documents related to the supervision of basic medical insurance funds in various cities in Guangdong Province,and the situation of fraudulently obtaining medical insurance funds.4 ResultsThe focus of medical insurance fund supervision policies in different cities in Guangdong Province is different.The medical insurance funds in the province have operational risks in terms of income,expenditure and balance.The intensity and intensity of medical insurance supervision in 2020 will be greatly improved compared with 2019,but the overall situation still exists.Insufficient;the DIP payment method used in Guangdong Province may have the problems of obvious over-medical treatment,high set scores,and transfer fees.5 DiscussionAll cities in Guangdong Province have issued relevant policies and conducted fund supervision,but their strength and methods need to be further improved.Therefore,intelligent supervision of medical insurance should be built,third-party forces should be introduced,and medical insurance payment methods and related policies should be improved.