Research On Consolidated Supervision Mechanism Of Designated Medical Institution In Basic Medical Insurance

China has already completed the basic medical insurance system entire coverage. Then the most important issue is to balance medical expenses and medical insurance fund. With the rapid economical development,the burden of fund expenditure become increasingly heavy. To maintain the basic medical insurance system operation smoothly, we must strengthen the supervision of the fund expenditure. The social security department as the insured interest agent, should play its dominant position to control medical expenses.All along, the social security department have done a lot of work in the aspect of supervision, to ensure the smooth running of the basic medical insurance system. But with the development of medical insurance to expand, if we still rely on means of restraint agreement management of the past, it will be very difficult to adapt to the new situation of the current medical insurance. Can we establish a comprehensive monitoring mechanism in the basic medical insurance system, to accomplish the social security departments effective management and constraints on the designated medical institutions? Based on this idea, the subject of the research is to explore the supervision of appointed medical institutions.This thesis included five parts totally.The paper began with introduction the research background, ideas, and methods, frame structure of the thesis, the main content and research contributions are the main contents.The second chapter mainly analyses the current management problem in the basic medical insurance system. Payment is paid according to the present situation of project, and the existence of the management system is not smooth, protocol management is weak, the current payment mode is difficult to control the medical expenses. Under this condition,we put forward that, as the medical expenses paying party, the social security department have rights to represent the insured person interest to regulate hospital behavior, and it also need more innovation supervision mode in order to solve the existing problems.The third chapter analyses the practice of supervision in some foreign country (German, British, American etc.) and some typical several current regulation mode in China.,like Shanghai, Nanning, Lianyungang.The fourth chapter set up the evaluation index system to evaluate the designated medical institution and make a classification scheme. Starting from the social security departments on the management of medical institutions function, this chapter designed the evaluation index system of the social security department to designated medical institutions. According this to assess the basic medical service designated medical institutions for the insured.The fifth chapter establish the investigation and analysis the existing index management, referring to the domestic and foreign advanced experience, will integrate the existing management, assessment mechanism, introducing competition mechanism, and eventually establish comprehensive rules, division and cooperation in different deparment, and adjust the regulatory mechanism.At the end,this chapter proposed the established of the hospital and physician incentive means.The innovation of this thesis is to put forward the thinking and evaluation method to designated medical institutions and graded management. Combined with the supervision practice to improve assessment system,and improved assessment mechanism to the designated medical institutions.Aiming at the shortage of current regulationwo is to set up a comprehensive regulatory scheme more perfect, including the implementation of departmental interaction, dynamic adjustment, establish the third party supervision mechanism, and put forward a scheme of incentive constraint mechanism of hospital and doctor.