Research On The Supervision And Management Of The Medical Insurance For Chronic Disease Outpatients In Weifang

The report of the 19 th National Congress of the CPC outlines the plan for universal insurance coverage for the purposes of constructing a better social security system and carrying out the “Healthy China initiative”.Thanks to universal participation,medical insurance funds continues to expand.The difficulties that governments and medical insurance agencies must address are about how to secure the sound operation of the funds,improve the efficiency of fund use,and prevent loss and waste.The sound operation of the funds not only signals the fairness and justice of the socialist system,but also boosts the confidence of the public on socialist welfare,both of which are conducive to the construction of a harmonious society.Under the background of comprehensively advancing law-based governance,it is imperative to exert better supervision and management over the medical insurance funds,and situate the supervision and management under the rule of law.Well-planned collection,reasonable payment,and a complete and sound supervision and management system constitute the premise for the funds to function properly.In this paper,the problems in the supervision and management of medical insurance for chronic disease outpatients of Weifang in Shandong province are analyzed and discussed by means of library research,case analysis,field research and others,on the basis of previous research and theories as well as the outstanding practices of other cities,for the purposes of pinpointing underlying reasons,making feasible policy suggestions and proposing improving measures.The following are mainly included:In the first part,the concept and characteristics of chronic disease outpatients covered by medical insurance are clarified by defining what is chronic diseases,which is then followed by an introduction of the theoretical basis for establishing the medical insurance system,that is,social equity theory and social welfare theory.In the second part,an introduction is made on the establishment,operation and daily supervision of medical insurance for chronic disease outpatients in Weifang.In the third part,analyses on the process of supervising medical insurance for chronic disease outpatients in different stages,and on the supervising subject,object and method are made to detect the problems and deficiencies in the supervision over medical insurance for chronic disease outpatients in Weifang.Through a detailed analysis of the problems found,the causes for these problems are clarified.In the fourth part,the advanced practices of Qingdao and Weihai in the supervision of medical insurance for chronic disease outpatients are introduced to find out their rational design and feasible practices in the supervision and management of chronic disease outpatients.In the fifth part,feasible measures and suggestions for the supervision of medical insurance for chronic disease outpatients in Weifang are put forward for optimizing the operation of the current medical insurance supervision system,including,improving the professional knowledge and information network skills of the supervisors to enhance supervisory performance on the basis of the existing staff size,improving information disclosure and the auxiliary role of third-party supervision to diversify supervision and management,offering more and better training on laws and regulations and relevant knowledge for medical staff and standardizing the behaviors of employees in medical institutions to reduce the incidence of fund operation violations,determining the types of chronic diseases and combined payment methods that are suitable for Weifang to improve the quality of medical services while reducing the cost of medical treatment for patients.