The Risk Management Research Of Urban Employee Basic Medical Insurance Fund Payment In Chengdu

The rapid development of the economy must rely on the strong support of the social security system.The complete social security system is the booster of the economic,whose foundation is the medical insurance system.The social medical insurance fund expenditure shows a trend of growing owing to expanding coverage of social medical insurance,increasing aging of population and unreasonable allocation of medical resource,which will pose a threat to the balance of social medical insurance fund.The payment of medical insurance fund is the key node in the operation of medical insurance system,which is also the most important function of medical insurance.At the same time,the payment of insurance fund is a way of economic incentive,which has obvious guiding effect on controlling medical cost,regulating medical behavior,allocating medical resource reasonably and regulating medical behavior.It is not only a sensitive link that can reach deeply into the economic interests of all parties concerned,but also the most difficult and major point of reforming and improving the health care system.The urban employee basic medical insurance(hereinafter referred to as UEBMI)is the most important part of medical insurance system.As the southwest district’s central city,Chengdu established the UEBMI in 1999,and has been actively exploring the way to perfect the UEBMI’s system,managing to avoid the UEBMI payment risk effectively,and to curb the unreasonable growth of UEBMI ‘s expenditure,in order to ensure the steady operation of the UEBMI.Based on the latest literature at home and abroad and related laws and regulations in medical insurance,this thesis has been deeply investigated the payment of Chengdu’s UEBMI fund,which supported by risk management theory,principal-agent theory,induced demand theory and so on,and combined qualitative analysis with quantitive analysis,then finally gave the risk management suggestions to Chengdu.First of all,this thesis introduced the research background,research purposes,research content and so on.Then confirmed the risk factors in the payment of UEBMI fund,and the weight of each risk factor is obtained through the analytic hierarchy process,the fuzzy comprehensive evaluation method is also used to evaluate these risk factors.After that,based on the operating UEBMI data of Chengdu from 2013 to 2017,this thesis deeply analyzed the key data,such as the income and expenditure of UEBMI fund,the insured structure,the designated medical institutions’ declaration expense and per person-time declaration expense.In the end,the thesis integrated the related Chengdu’s UEBMI policies and domestic and foreign advanced experiences in medical insurance fund payment risk management,from the perspectives of standardizing the behavior of the supply and demand sides,alleviating the pressure of population aging,reducing the risk of UEBMI payment so as to ensure its sustainable operation and so on,offered suggestions to medical insurance institutions,medical institutions and demand side of medical insurance,provided useful reference to Chengdu for the reform of the UEBMI payment method and UEBMI’s improvement and deepening,which would have a positive effect on the whole medical security system in Chengdu.The innovation of this thesis was to focus on a certain district of China,integrate the existed qualitative analysis of medical insurance industry,and put forward the risk management countermeasures which are suitable for the fund payment of basic medical insurance,and propose risk management countermeasures that are fit for Chengdu.Furthermore,it provided scientific and reasonable suggestions for risk management of UEBMI payment in Chengdu even in southwest district.