Study On Risk And Countermeasures Of Basic Medical Insurance Fund For Urban Workers In Shanxi Province

As one of the important projects of the people's livelihood in China,the medical security system has met the basic needs of the people who are sick and cured,and China is building the medical security system with Chinese characteristics in an all-round way.One of the important components of the basic medical insurance is the basic medical insurance for urban workers.It is the earliest to establish and operate,which satisfies the medical needs of the insured workers and promotes the stability of the society and the sustainable development of the economy.The basic medical insurance fund for urban workers is the guarantee of its system development,but there are more and more risks in the operation of the fund.In order to ensure the safe operation of the fund,it is necessary to pay attention to the study.The basic medical insurance system for urban workers in Shanxi Province has been constantly improving and developing,the scale of its fund revenue and expenditure is also expanding,the operation of the same fund is also facing a variety of risks,in order to ensure the safe operation of the people's life-saving money,After mastering the related concept theory,this paper expounds the basic medical insurance policy for urban workers in Shanxi Province and the specific provisions on fund raising,allocation and payment,from the situation of the insured personnel,the income and expenditure of the fund,the fund's current balance,and so on.This paper analyzes the operation status of medical insurance fund for urban workers in Shanxi province from the aspects of accumulated balance,and at the same time,based on the collection of basic medical insurance fund for urban workers in Shanxi province Based on the detailed data,the grey forecasting model is selected to predict the income and expenditure of the basic medical insurance fund for urban workers in Shanxi Province from 2018 to 2025.The results of the forecast are analyzed,and it is found that the fund may face the risk of payment in the future that the fund will not exceed expenditure in the current period.And there are all kinds of risk of collection,payment and management in the operation of the fund,the enterprises in the collection,the risk of non-payment,the risk of false base of payment,the risk of system and policy,the social risk of aging population in payment.The moral hazard of both sides of the medical market,the risk of illegaloperation in management,the risk of information system,the risk of supervision and so on.There are many reasons for collection,payment and management risk of medical insurance fund for urban workers in Shanxi province.The risk of collection mainly lies in the collection strength of collection institutions is not strong,the base of payment declaration is not true,insured personnel's choice of opportunity to participate in insurance;The forecast of the fund's income and expenditure from 2018 to 2025,the aging of the population and the rapid growth of the medical expenses make the risk of the fund's operation constantly increasing,and there may be the risk that the current income of the fund will not exceed the expenditure of the fund in the future.The management lags behind,the supervision intensity is insufficient has caused the management risk.In order to promote the safe operation of the fund,to prevent and resolve the risks,comprehensive policy should be applied,and the basis of payment should be carried out.Special audit to ensure that the fund is raised in place,improve the level of overall planning,the participation rate of staff and workers,expand the number of people to participate in insurance,improve the collection and collection of funds;Many ways to control the sharp increase in medical expenses,under the leadership and management of the Shanxi Medical Security Bureau,improve management efficiency,attach importance to the risk prevention and control of the fund,severely crack down on the fraud and fraud of medical insurance funds,and build an intelligent monitoring network.Multi-department linkage,improve the level of supervision,so that the safe operation of medical insurance fund for urban workers in Shanxi Province,sustainable development.