Study On Payment Management Of Basic Medical Insurance For Urban And Rural Residents

The basic medical insurance system for urban and rural residents is a basic system to ensure the people’s livelihood in our country,which can realize the coordination and deployment of a certain amount of funds within a certain range.The good operation of the system is an important starting point for the sustainable development of medical security funds.In January 2016,China issued the "Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents",which has entered the stage of combining the new rural cooperative medical insurance with the basic medical insurance for urban residents.Since the implementation of this system,the balance of the medical insurance fund in this part has shown an overall downward trend,and there is a risk of deficit.This thesis focuses on the payment management of the medical insurance pooling fund during the operation of basic medical insurance for urban and rural residents in Q District,and divides the payment management into two parts: payment form management and payment fund management.First of all,the author sorted out the relevant theories of the basic medical insurance system for urban and rural residents,and reviewed the domestic and foreign researches on the factors of rapid rise in medical costs and related factors of medical insurance payment management under the background of rising medical costs.Secondly,this thesis analyzes the current situation and problems of payment management of basic medical insurance for urban and rural residents in Q District by using public goods theory and stakeholder theory,supplemented by literature research method and interview method.The investigation and analysis found that in Q District,there are mainly induced demand from medical service providers,unreasonable demand for medical services,and shunning of insured patients by medical institutions.There are three reasons for this:first,the payment method is backward;second,both the medical service provider and the served party have moral hazard;third,the payment standard is unreasonable.Finally,the author summarized the current national policies and advanced experience of other provinces and cities,explored the countermeasures suitable for Q District,and proposed reasonable fee control,innovation of payment methods,establishment and improvement of supervision mechanism,scientific and reasonable payment standards and other countermeasures for Q District,in order to provide theoretical and empirical reference for the payment management of basic medical insurance for urban and rural residents in Q District.