Problems and countermeasures about the operation of the health insurance fund

Medicare funds is the relationship between workers livelihoods funds, and pension, unemployment and maternity insurance funds are referred to as enterprise workers "Survival Money for better management and utilization of medical insurance fund, the protection of the rights and interests of workers, maintaining social stability and building a harmonious The society has important significance.

Health insurance fund the implementation of the national management, social systems do, the right of everyone to the enjoyment of the enterprise workers management model, enterprise workers can fundamentally solve the medical treatment is difficult to see a serious illness is more difficult practical problems, promote the improvement of the health of the people, to further improve China's social security regime. In support of Party committees at all levels of government attention in recent years, the health insurance fund from scratch, from less to more gradually strengthen the management of the health insurance funds gradually become institutionalized and standardized but with the further development of the social economy, raising the level of health of the people, the operation of the health insurance fund gradually exposed some problems, so much in need of improvement and corrective.

Analysis of the main problems in the current health insurance fund run and why

(A health insurance fund collection low social coverage needs to be further expanded. Currently, the health insurance fund financial dependents enjoy enterprise workers accounted for only part of the main problems: First, some enterprises with good returns are not included in the collection range due to unpaid pay and thus not able to enjoy the health insurance fund, some concerns and awareness deviation of unit based insurance fund run on the collection medical insurance fund, the enthusiasm is not high, resulting in some of the health insurance fund is unable to raise; Third, some units effective poor business downturn, weakness insured. majority of enterprise workers do not have health insurance fund personal accounts narrow coverage of the health insurance fund.

(B financial subsidies in place low, low reimbursements due to local financial difficulties, a year arrange health insurance funds on the budget, most of the inpatient reimbursement is 35% of the total cost of less than hospitalization highest individual serious illness reimbursement only one hundred thousand element, see the individual family poverty caused by the serious illness is difficult to become a very prominent issue in the health insurance fund personal accounts annually levied at 2% of the total wages and financial grants 1%, individual local financial subsidies few are still not in place, contusion the workers to pay health insurance fund personal enthusiasm of the funds in the account.

(The three Medicare funding agencies violation reimbursement costs, squeeze Medicare funds. Certain county two disabled veterans cost reimbursement in Medicare funds, health insurance funds for retired workers, farmers should be listed separately, reimbursement alone, but mixed with Medicare funds , be reimbursed the original constraints Medicare funds such as the exhaust Ze fish, Medicare capital reimbursement management work for further improvement of these problems, mainly clerks is not strong sense of responsibility, a sense of law and order causes.

(D irregularities extracted from Medicare funds for office expenses., Phone bills, travel, utilities, printing and other expenses required in the health insurance funds run could not pay due to some local finance office expenses set aside only a few individual health insurance funding agencies violations extracted from the health insurance funds disbursed office expenses, health insurance funds misappropriated.

(Five designated medical institutions, out of touch with the health insurance fund organizations management. The Medicare funding agencies responsible for reimbursement of medical expenses, to check the quality of service of the designated medical institutions designated hospitals responsible for doctor, hospital admissions and other work, not strict identity confirmation into inpatient , The resulting Some farmers mixed with Medicare patients, also reimbursable expenses, some social security patients into inpatient admission unsound management is chaotic, should be in the area can cure the disease, illegal referral to health insurance agencies check business difficult. reasons: First, the health insurance fund management agency personnel, financial constraints, lack of strict inspection of designated medical institutions often resulting into inpatient procedures unsound, the retroactive failed to timely re-submit the disqualification did not timely identification designated medical institutions, status and responsibility is not perfect, the lack of effective disciplinary supervision and restraint, resulting in some of the officers practicing favoritism, illegal operations. third is the lack of a well-established health insurance fund management organizations and designated hospitals post system, the lack of effective mutual restraint mechanisms.

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(The six designated medical institutions for the implementation of charges is not standardized, there are arbitrary collection of phenomena. Certain county in 2006 to social security patients receive an equipment cost of 10 yuan, there 乱收费现象 15% of the purchase price on the price of drugs should be The price and the implementation of national price ceiling standards, but in parts of the violations at 100% of the purchase price of the fare increase, thereby increasing the economic burden of the inpatients.

(Seven designated medical institutions beyond the scope of drug abuse inspection items designated medical institutions should be performed according to << provinces and cities designated medical institutions, service charges and drug list ", but there are still beyond the scope of individual local charges and beyond the scope of medication, resulting in improve the social security of patient costs as a county designated medical institutions for special care fees charged to patients, individual doctors to sell drugs of some merchants, to reap personal gain.

Second, the specification of the recommendations of the health insurance fund run

1, step up publicity efforts to raise the insured awareness of the whole society, to further expand the coverage of the health insurance fund. Actively mobilize enterprises have insured condition Medicare management agency door service, improve efficiency, and further expansion of health insurance coverage. Should give full play to the broadcast , the role of the television news media and public opinion, and widely publicized, reports some typical examples of health insurance, health insurance policies known, well known. poor efficiency of enterprises, should consider the financial subsidies to support the insured, further expansion of individual health insurance funds the scope of the account, thus expanding the coverage of medical insurance fund, gradually covering every corner of the town's health insurance fund.

2, strengthen the supervision of the health insurance funds, run specification funds. Supervision Organization by the competent authorities, the payment unit representatives and experts to participate in medical insurance, Medicare funds to implement the regular announcement sun operation, accept social supervision. Inspection and supervision of higher authorities, financial and audit department regularly or irregularly, plug the loopholes in a timely manner, to prevent the occurrence of illegal reimbursements. Governments at all levels should be the overall planning and coordinating all audit identified the problem, it is timely to convene the meeting , study and solve the people's livelihood. requirements of the health insurance fund management institutions, local finance should be included in the budget, as a guarantee. localities should be based on their own financial situation in a timely manner to increase people's livelihood inputs, financial subsidies to make health insurance fund personal accounts in place to further stimulate and Mobilization of consciousness and enthusiasm of the majority of the insured.

Health care management organizations and designated medical institutions should gradually implement networking, to simplify procedures and improve efficiency. Designated medical institutions for inpatient medical service charges, drug prices online check, reimbursement of medical expenses, settlement of funds to do to know what's what.

3, the establishment of the convergence mechanism improve the health insurance fund management institutions and designated medical institutions, the common proper management and use of the health insurance funds. Designated medical institutions is to establish the responsibilities of doctors made careful review of Medicare patients, defining identity, adhere to the principle of impartial. lack of procedures for patients, should complement deadline, establish and improve patient medical records. recurring inspection the Medicare fund management institutions to conduct the business of the designated medical institutions, pointed out that the discovery of the problem in a timely manner, and promptly correct. designated medical institutions for the implementation of the business appraisal take the red, green, yellow Scoring System on the red light conversation commandment Free, quality of service still had slipped, until the abolition of the qualification of the designated medical institutions, to reward designated medical institutions with a high quality of service, increase the investigation on the illegal units efforts, the implementation of management who is responsible to regulate the operation of the health insurance fund management institutions and designated medical institutions should collaborate closely with the strict implementation of the management and operation system to ensure that funds safe and efficient operation.

4, strengthen self-construction, improve service levels should pay greater attention to the health insurance fund management institution-building, enrich the staff, with strong with excellent group to understand the medical will be financial, proficient in computers and other specialized personnel, human resources guarantee for the work. business people to strengthen the study of political theory, improve their own quality, and enhance a sense of discipline, adhere to the principle of handling matters impartially enforce the law impartially and improve service levels. designated medical institutions to continuously improve the quality of medical services, office people are satisfied with the hospital social security patients at ease, to create a good health care environment.

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