Research On The Internal Control Effectiveness Of Medical Insurance Fund Of YZ Central Hospital

As the main carrier of the medical insurance fund’s operation, the medicalsupplier is the pivot between the medical payer and the medical demander. So themedical supplier is the key that protects the operation of the medical insurance fund.However, excessive gross control and massive loss have appeared in the process ofusing and managing medical insurance fund conducted by hospitals. The internalcontrol of hospital medical insurance fund has widespread defects. Therefore, thestudy on the effective issues of internal control in hospitals has important practicalsignificance. Although YZ central hospital is the biggest public hospital of YZ city,there are many problems. In view of this, this paper concerns internal controleffectiveness of YZ central hospital in the perspective of medical supplierperspective.At first, based on the unit system, internal control, system evaluation theory,combined the internal control actual situation of the medical insurance fund of YZCentral Hospital, according to the COSO overall frame, an internal controleffectiveness index system is constructed. Secondly, a fuzzy comprehensiveevaluation model is used for the YZ Central Hospital to evaluate the internal controleffectiveness of medical insurance fund. The evaluation results show the effectivenessof internal control of the hospital medical insurance fund is invalid. Based on theevaluation results, this paper analyses the reasons lying behind. It turned out thatorganizational culture, monitoring and incentive are the key to the effectiveness ofinternal control. Finally, according to these key factors, we put forward someimprovement measures through the establishment of internal control responsibilitysystem in medical insurance fund, the enhancement of the internal control system, theenforcement of the information management in medical insurance fund, and theimprovement of the performance appraisal mechanism.