Research On The Legal System Of Medical Insurance Fund Supervision In China

The medical insurance fund is the economic base to guarantee the stable operation of the medical insurance system in China,but it has been facing the double pressure of income and expenditure all the time.Especially in the aspect of fund expenditure,due to the lack of hospital system and drug market reform in our country,there are widespread problems such as compensating for medical treatment with drugs,excessive inspection and high drug prices.At the same time,due to the imperfect regulatory system,incentive and restraint mechanism and other reasons,insurance fraud is repeatedly prohibited,which not only increases the burden of public medical treatment,but also leads to excessive consumption and even waste of medical insurance funds,thus hindering the control of medical insurance funds in China.At present,the phenomenon of fraud and insurance fraud in the medical field is emerging one after another.In order to keep the people’s "life saving money" firmly,it is necessary to establish and improve the medical insurance fund supervision system and mechanism,and severely crack down on fraud and insurance fraud.In this way,the medical insurance fund can manage both the present and the long-term.The first is to build a comprehensive supervision mechanism,implement cross-department coordinated development,and promote the comprehensive law enforcement of multidepartment;Secondly,improve the medical insurance regulatory legislation and implement the main responsibility of designated medical institutions.The third is to actively introduce third-party supervision to promote the effective operation of medical insurance supervision.The fourth is to promote the construction of medical insurance credit system and credit classification management.Fifth,strengthen the implementation of the fund’s revenue and expenditure budget;The sixth is to establish the payment method as the total amount of advance payment system.This paper is divided into five parts: The first part is the introduction,which mainly introduces the research background and significance of this paper,the research status at home and abroad,the research methods of this paper,as well as the innovation and shortage of this paper.The second part is the theoretical analysis of the legal system of medical insurance fund supervision,including the definition of medical insurance fund supervision,the theoretical explanation of medical insurance fund supervision and the value orientation of medical insurance fund supervision.The third part is the analysis of the legal system of medical insurance fund supervision in China,including the development course,the current situation and the existing problems of the legal system of medical insurance fund supervision,mainly including the imperfect legal system of medical insurance fund,the failure to establish a special law enforcement team,and the weak sense of responsibility of designated medical institutions.The lack of selfmanagement,medical insurance fund supervision and credit system is not perfect and medical insurance fund cost control mechanism is not reasonable.The fourth part refers to the relevant experience of foreign countries on the regulation of medical insurance fund.This paper selects Germany,the United States and the United Kingdom.The fifth part is the suggestions for the improvement of the legal system of medical insurance fund supervision in China,including expatiating the five basic principles of medical insurance fund supervision,clarifying the rights and obligations of medical insurance fund supervision subjects and improving the cost control mechanism of medical insurance fund.