Research On The Supervision Of Medical Insurance And Medical Services In Ningxia

With the rapid development of China's medical security system,the rapid development of the scale of medical insurance fund,the difficulty of regulation s also growing,which put forward higher requirement to the supervision mechanism,supervision mode and regulation abilities of medical insurance staff.Medical service supervision in medical insurance as a guarantee of the basic medical needs,reduce the waste of medical resources and an important means to control the irrational increase of medical expenses,it is an integral aspect in the construction of the medical security system and an important guarantee for sustainable development of the medical security system."The regulation problems of medical service for patients participating"is the research object of this paper,from the perspective of Ethnic Areas,using the method of literature and experience summary to learn from the experience.On the basis of practical research,the current situation of the medical service supervision in medical insurance is summarized from the aspects of the main medical insurance policy,the basic situation of regulation,the form and the processing method of the irregularities.2 pieces of experiences of medical service supervision in medical insurance in Ningxia is achieved from the 5 years practice,the first is the supervision department of Ningxia area has initially established an effective supervision system and the mechanism of medical service for patients participating in medical insurance in the Autonomous Region,the city and county.Based on the present situation of medical insurance in the Ningxia Hui Autonomous Region,the national medical service monitoring system is proved and the function of medical knowledge base and the Physician integrity management system is developed.Behavior of over-treat,violation fees and irrational use of drugs reduced substantially.The enlightenment summarized from the exercise is the management is important as control,the two sides promote each other,not a single one can be omitted.The key point is to focus on typical cases of violation,the recurring problems,strengthen the deterrence.There are still many problems existing in the medical service supervision in medical insurance such as difficult to identify irregularities,difficult to supervise Off-site medical treatment expenses,incomplete and non-standard data information,shortage of professional supervision staff,etc.The main causes of these problems are system factor,the mechanism factors,and legal factor.In order to maintain the sustainable development of the medical insurance system,safeguard fairness and justice,the suggestion such as continuously improve the medical service supervision in medical insurance from the aspect of the system,the mechanism,the legality of medical insurance,strengthen the management of medical services agreement,make good use of national medical service monitoring system,construct multiple supervision system of medical service for patients participating in medical insurance service is needed.