Research On The Social Medical Insurance Fund Risk Control Of City A

Social medical insurance system is an important component of the social security system. Whether social medical insurance fund is safe or not, is not only related to the vital interests of the insured, but also affect the sustainability of the medical insurance system. Many factors cause the surge of social medical insurance fund expenditure, such as emerging of favorable policies, the growth of medical costs in recent years, growing aging process and so on. The limited income and unlimited expenditure form the contradiction which seriously breaking the social insurance fund’s balance. Social medical insurance fund making ends meet is common in many cities of our country. To social medical insurance agencies, analyzing and controlling the risk of social medical insurance fund is an urgent task. The social medical insurance system for urban workers has implemented since 2001 in city A. With the gradual expansion of the insured scale, the insured structure is aging, selective enrollment is more serious, per capita expenditures annually surge, and medical insurance units’violations are more common in previous years. The accumulated fund of 2012 has been insufficient to pay expenditures that year. Combining risk management theory, the article study controlling risk of social medical insurance fund according to risk management process, which consists of risk identification, risk assessment and risk control. First, social medical insurance risk is classified into internal risks and external risks according to social security classification. Then on the basis of operating data from 2009 to 2012, assess the social medical insurance fund risk of city A through analyzing fund surplus, insured structure, insured task completion, per capita expenditure and irregularities cases by the combination of quantitative and qualitative methods. Finally, specific practical risk control measures are proposed according to composing, raising and spending of city A’s social medical insurance fund and excellent experience at home and abroad, which provide some practical reference to control opinions. These measures are from four perspectives which are constraints to both demand and supply side, easing the pressure of population aging and establishing medical insurance fund risk warning mechanism, including accelerating payment reform, consciously and actively encouraging insured, the insured structure optimization, the introduction of social medical insurance actuarial models.The innovation of this article is putting forward risk control measures in line with the actual situation of city A, combined with qualitative analysis of the health insurance fund risks at home and abroad, which is on the micro-data of city A. The analysis and measures have practical impact on city A’s medical insurance fund operation.