Research On The Supervision Of Local Government Basic Medical Insurance Fund

Medical security is an important institutional arrangement to reduce the cost of medical treatment and maintain social stability.The safe and stable operation of the medical insurance fund is the main prerequisite for the system to play its role.However,with the deepening of the medical insurance reform,the fund supervision is becoming more and more difficult,and the problems are gradually highlighted,and the phenomenon of insurance fraud occurs from time to time.Therefore,how to study the existing problems of medical insurance fund supervision and how to improve the supervision mechanism is an important topic to promote the high-quality development of medical insurance.This paper takes the existing problems in the supervision of local government medical insurance funds as the entry point to explore,mainly including the following contents:First of all,the definition of basic medical insurance,basic medical insurance fund and medical insurance fund supervision is explained,and the theoretical knowledge of information asymmetry,induced demand and cooperative governance is used for reference to lay a solid theoretical foundation for the study of this paper.Secondly,Qingdao is selected as the research object,literature research method,case analysis method and questionnaire method are used to analyze the actual situation of medical insurance fund supervision and management in Qingdao.It points out that the existing problems include unsound laws and regulations on the supervision of medical insurance funds,unscientific and reasonable payment methods,lagging methods and means of the supervision of medical insurance funds,insufficient investment in "human and financial resources" in the supervision of medical insurance funds,unsound information data system of the supervision of medical insurance funds,weak sense of responsibility of designated medical institutions,and insufficient social supervision.And deep analysis of the causes of the problem.Finally,on the basis of summarizing the above,combined with the actual situation of Qingdao,put forward relevant suggestions.The first is to establish a closed-loop and whole-process supervision system of medical insurance funds,that is,to improve the laws and regulations on medical insurance fund supervision,deepen the reform of medical insurance payment methods,improve the multi-stage linkage supervision mechanism,strengthen the construction of law enforcement teams,and improve the smart medical insurance fund supervision system.The second is to improve the credit supervision system of medical insurance fund of medical institutions,namely to implement credit supervision of medical insurance fund and strengthen the standardized management of designated medical institutions themselves.The third is to improve the social supervision mechanism of medical insurance funds,namely to establish a diversified social co-governance mechanism and a social supervisor mechanism.