Research On The Control Of High Zero-reported Medical Insurance Expenses In Shanghai

Medical and health care is a major livelihood issue affecting the health of hundreds of millions of people,and an important factor affecting people's happiness.Medical insurance,as an important guarantee for health expenditure,is closely related to the harmony and stability of the whole society.Strengthening the management of medical insurance fund can maintain the balanced and efficient use of medical insurance costs,prevent the risk of fund operation,effectively reduce the loss of funds,and better protect the fundamental interests of the most insured people.High zero reporting is an important part of medical insurance audit,which accounts for a large proportion in the use of the entire medical insurance fund.It is of great significance to study the use of high medical expenses and control the cost of medical insurance.Through manual audit,urban linkage can better find problems,greatly boost the later audit and control of illegal expenses,and control illegal expenditures.Based on the 2017 annual high and reported more than 3000 cases in the city as the research object,through spss19.0 affecting factors of the high cost of software for data analysis,from the age,sex,hospital/clinic,total cost,single or single day 'expenses,proportion of deductions,health care category,ginseng protect way,whether the audit according to the field,to go to a doctor,hospital level do system analysis,the classification of diseases,etc.Through data analysis and case analysis,the following conclusions are drawn: 1.The high cost of zero report audit is relatively high,which accounts for a higher proportion of the city's medical insurance,and the risk content is relatively high.2.There is a relatively high concentration of diseases,including tumor,cardiovascular disease and uremia.3.There are obvious regional differences in the cost of the audit materials and the types of medical insurance.3.There is a significant age difference in the cost of auditing materials.The older the material is,the higher the cost is.4.The proportion of expenses is prominent,and the proportion of drug consumables is relatively large.5.There are many irregularities hidden in the high-value zero-report,which is of high secrecy and difficult to audit.From the government's point of view,this paper puts forward a series of solutions to the contradictions among the relevant subjects,from the institutional level: improving medical insurance payment,three-level diagnosis and treatment,market norms,prevention and pension system,and effectively analyzing the four stakeholders and putting forward appropriate means of checks and balances of interests,so as to effectively restrict the forces of all parties in medical insurance so that they can perform their respective duties.