Exploring the Audit Supervision of China’s Medical Insurance Fund Based on the 2019 Medical Insurance Fund Audit Data

This study is mainly based on the auditing of medical insurance funds in the audit work report of the National Audit Office’s 2019 central and provincial and municipal budget implementation and other fiscal revenues and expenditures to conduct audit supervision of China’s medical insurance funds, based on the risk-oriented violation of regulations. Identify and evaluate the risks of each stage of the medical insurance fund from the perspective of risk of breaches, thus draw audit points, summarize the path of the medical insurance fund audit supervision so that that audit resources can be concentrated in important stages and key areas. Audit costs can be reduced, and build the regulatory system of the medical insurance fund audit will be constructed accordingly.

Download Full-text

Reforming Payment Methods for Basic Medical Insurance to Accommodate Traditional Chinese Medicine (TCM) in China : A Case Study of Shaanxi Province

10.21203/rs.3.rs-25851/v1 ◽

2020 ◽

Author(s):

FANG ZHOU ◽

XIAOHAO ZHANG ◽

ZHIGUO MA

Keyword(s):

Medical Insurance ◽

Diagnosis And Treatment ◽

Shaanxi Province ◽

Insurance Fund ◽

Payment Methods ◽

Treatment Services ◽

Basic Medical Insurance ◽

Medical Institutions ◽

Insurance Funds ◽

Basic Medical

Abstract Background: Traditional Chinese medicine (TCM) attaches importance to the philosophy of holism and disease prevention. Meanwhile, costs arising from TCM diagnosis and treatment services are relatively low. Such features cater to the needs of less developed countries and regions to increase the equity and accessibility of medical services and to save basic medical insurance funds. However, China’s current payment system for basic medical insurance fails to fully regard these features, thus unable to incent the demand for and supply of TCM services. Methods: Based on the analysis of the features or rather the advantages of TCM, the article, taking Shaanxi Province located in central China as an example, studies the status quo of economic development, coverage of TCM diagnosis and treatment services by basic medical insurance, implementation of payment methods for basic medical insurance in TCM medical institutions, and aims to explore the reformation of payment methods for basic medical insurance. Results: Statistics have shown that the economic power of Shaanxi Province is below average in China, as a result of which, Shaanxi Province is confronted with a general lack of basic medical insurance fund. On the other hand, the present payment methods for basic medical insurance fail to accommodate the features of TCM. Besides, only a very limited number of TCM medical institutions, service items and medicines are covered by basic medical insurance. Consequently, the advantages of TCM are not exploited to the full in a country that has always treasured TCM. Therefore, reformation in payment methods is pressing. Conclusion: In view of the economic and social development of Shaanxi Province, this article proposes to reform the payment methods for basic medical insurance by introducing a new medicinal-effect-based payment method to accommodate TCM. This payment method has the following four features. Firstly, it advocates strengthening process supervision of diagnosis and treatment activities in medical institutions, establishing a rating system for therapeutic or prophylactic effects, and implementing a reward and punishment mechanism accordingly. Secondly, special audit standards for TCM services shall be determined by the health care department of the people’s government together with the relevant TCM administrative department, more TCM institutions, service items and medicines shall be covered by basic medical insurance, and the negotiation mechanism with medical insurance institutions shall be adjusted. Thirdly, in pricing the fees and standards for TCM services, the price control administrations of the people’s government shall consult TCM experts, and dynamic price adjustments based on costs and professional technical values shall be made. Last but not least, outpatient diagnosis and treatment services shall be covered by basic medical insurance fund, a practice which will not only give full play to the advantages TCM services, but also help reduce the financial burden on patients and save medical insurance funds.

Download Full-text

The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China’s urban and rural residents’ medical insurance

BMC Public Health ◽

10.1186/s12889-021-11367-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinjie Zhang ◽

Jingru Huang ◽

Ying Luo

Keyword(s):

Medical Insurance ◽

Insurance Fund ◽

Ageing Population ◽

Fertility Intention ◽

Rural Residents ◽

Basic Medical Insurance ◽

Urban And Rural Residents ◽

Child Policy ◽

Insurance Funds ◽

Basic Medical

Abstract Background With the rapid growth of the ageing population, the operating burden of China’s basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability. Methods We used an actuarial science method and took the urban and rural residents’ basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds. Results Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed. Conclusions The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.

Download Full-text

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

10.21203/rs.3.rs-133184/v1 ◽

2020 ◽

Author(s):

Juming Liu ◽

Yihua Xu ◽

Yiqing Yang ◽

Kaifu Luo ◽

Yangyang Hong ◽

...

Keyword(s):

Health Service ◽

Medical Insurance ◽

Medical Community ◽

Insurance Fund ◽

County Level ◽

Medical Expenses ◽

Insurance Funds ◽

Per Capita ◽

Underdeveloped Areas ◽

The Stability

Abstract Background:Due to the irrational structure of medical and health resources, uneven distribution, and low level of grassroots services, traditional medical insurance payment methods in China’s underdeveloped areas have not been fully utilized in regulating medical service behaviors and guiding the allocation of medical resources. The medical insurance fund of many regions collapsed, the fund balance rate and compensation rate decreased year by year, and the medical expenses rose rapidly, which seriously affected the enthusiasm of the insured residents. As a results,the sustainable development of the medical insurance fund faced many difficulties and challenges.Based on this, we want to design a medical insurance policy suitable for underdeveloped areas in China to improve the capacity and efficiency of health services and maintain the stability of medical insurance funds.Methods:Collected medical insurance data of Y County in China from 2018 to 2019.The interruption time series(ITS) was used to evaluate the utilization of medical insurance funds in county-level hospitals, primary health service centers, and hospitals outside the medical community.Results:Inpatient expenditure(IE) per capita,out-of-pocket inpatient expenditure(OIE) per capita,and medical insurance expenditure (MIE)per capita in county-level hospitals increased by 84.682, 6.564 and 62.302 yuan per month respectively after the reform; Number of annul discharges persons(NOADP)from basic health service centers increased by 36.899 per month after the reform; IE per capita and MIE per capita increased by 18.624 yuan and 15.767 yuan per month on average after the reform; the residents hospitalized outside CCMC decreased by 9.545 per month on average after the reform. Conclusions:China should further implement the CCMC-based TMIPPM reform to control medical expenses and maintain the stability of medical insurance funds in in more trials.

Download Full-text

Fiscal Decentralization, Local Competitions and Sustainability of Medical Insurance Funds：Evidence from China

Sustainability ◽

10.3390/su11082437 ◽

2019 ◽

Vol 11 (8) ◽

pp. 2437 ◽

Cited By ~ 2

Author(s):

Qian ◽

Cheng ◽

Lyu ◽

Zhu ◽

Keyword(s):

Financial Aid ◽

Local Governments ◽

Central Government ◽

Fiscal Decentralization ◽

Medical Insurance ◽

Negative Influence ◽

Insurance Fund ◽

Spatial Autoregression ◽

Insurance Funds ◽

Social Medical Insurance

Local governments are responsible for the management of social medical insurance for urban and rural residents in China. Under the background of fiscal decentralization between the central government and local governments, the strengthening of supervision on medical insurance funds by local governments leads to a reduction in the expenditure of the medical insurance fund, which contributes to its sustainability. By employing the provincial level panel data during 2004–2014, we used a fixed effect model and a spatial autoregression model to investigate whether fiscal decentralization has had a negative influence on the expenditure of China’s new rural cooperative medical system (NCMS) fund. We found that fiscal decentralization has had a significant influence over its per capita expenditure. Our results also indicate that higher fiscal decentralization leads to higher financial aid in the NCMS provided by local governments. Additionally, the expenditure of the NCMS and the local financial aid are influenced by nearby governments. Our results suggest that appropriate fiscal decentralization, which helps to maintain the sustainability of social medical insurance funds, should be encouraged.

Download Full-text

Allocation of funds of the standardized safety stock of compulsory health insurance funds for advanced training of medical workers, purchase or repair of medical equipment: new procedure

Buhuchet v zdravoohranenii (Accounting in Healthcare) ◽

10.33920/med-17-2104-05 ◽

2021 ◽

pp. 56-63

Author(s):

O.V. Shinkareva ◽

S.I. Oparina

Keyword(s):

Professional Education ◽

Medical Equipment ◽

Medical Insurance ◽

Insurance Fund ◽

Advanced Training ◽

Safety Stock ◽

State Information ◽

Insurance Funds ◽

Compulsory Health Insurance ◽

Health Insurance Funds

The article is devoted to a new procedure for medical organizations to use the funds of the standardized safety stock of the Federal Compulsory Medical Insurance Fund and the territorial compulsory medical insurance fund, which is aimed at financing the organization of additional professional education of medical workers under advanced training programs, as well as the acquisition and repair of medical equipment. The main provisions of this Order, which entered into force on March 1, 2021, are considered. It is noted that starting from 2022, the maintenance of the plan and territorial plan of events for the use of these funds, as well as the reporting provided by medical organizations based on the results of such events, will be organized in electronic form using the state information system of compulsory medical insurance.

Download Full-text

SOCIAL INSURANCE IN RUSSIA: STATE, CURRENT CHALLENGES AND RESPONSES TO THEM

Scientific Review Series 1 Economics and Law ◽

10.26653/2076-4650-2020-1-2-07 ◽

2020 ◽

pp. 75-95

Author(s):

Lyudmila A. Migranova ◽

◽

Valentin D. Roik ◽

Keyword(s):

Social Insurance ◽

Pension Fund ◽

The State ◽

Insurance Fund ◽

Social Risks ◽

Social Insurance Fund ◽

Subsistence Minimum ◽

The Social ◽

Mandatory Health Insurance ◽

Insurance Funds

The article deals with the issues of functioning of the social insurance institution, the organizational-legal and financial forms of which are presented by the state extrabudgetary social funds - Pension Fund of Russia, Mandatory Social Insurance Fund and Mandatory Health Insurance Fund. It considers the main characteristics of social insurance: a) scope of covering the employed population by insurance protection; b) contribution rates as related to wages; c) level of protection of population incomes (pensions and benefits as related to wages and subsistence minimum); d) availability of quality medical assistance and rehabilitation services. There are analyzed the present social risks and problems of the RF insurance system. The main problem is that the amount of financial expenditures on all types of social insurance per beneficiary is about half that of most developed and developing countries. The primary cause is lacking motivation of both employees and employers to participate in the mandatory social insurance and to legalize their earnings. In the conclusion there are formulated a number of proposals for improvement of the institution of social insurance in Russia. It is proposed to expand the range of insurance cases concerning unemployment insurance and care for elderly people, to increase the total amount of compulsory contributions to extrabudgetary insurance funds from 30.2% up to 42.5% from three sources - employees, employers and the state.

Download Full-text

Organization of immunobiological therapy for severe bronchial asthma in the Sverdlovsk region

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja1414 ◽

2021 ◽

Author(s):

Evgeny K. Beltyukov ◽

Valery A. Shelyakin ◽

Veronika V. Naumova ◽

Alexander V. Vinogradov ◽

Olga G. Smolenskaya

Keyword(s):

Differential Diagnosis ◽

Targeted Therapy ◽

Medical Care ◽

Clinical Guidelines ◽

Medical Insurance ◽

Continuation Therapy ◽

Insurance Program ◽

Routine Medical Care ◽

Insurance Funds ◽

Stay Hospital

Background: Biologicals use in severe asthma (SA) is associated with problem of targeted therapy (TT) availability. Ensuring availability of biologicals can be resolved within the territorial compulsory medical insurance program (TCMIP) in day-stay or round-the-clock hospital. Aims: development and implementation of program for introduction of immunobiological therapy (IBT) for SA in Sverdlovsk Region (SR). Materials and methods: Program for introduction of IBT for SA was developed in SR in 2018 to provide patients with expensive biologicals within the TCMIP. Program includes: SA prevalence study in SR; practitioners training in differential diagnosis of SA; organization of affordable therapy for patients with SA; register of SA patients сreation and maintenance; patients selection and management of patients with SA in accordance with federal clinical guidelines. Results: Atopic phenotype in SA was detected in 5%, eosinophilic - in 2.3% of all analyzed cases of asthma (n=216). Practitioners of SR were trained in differential diagnosis of SA. The orders of the Ministry of Health of SR were issued, regulating the procedure for referring patients with SA to IBT, a list of municipal medical organizations providing IBT in a day-stay or round-the-clock hospital; approved regional register form of SA patients requiring biologicals use; ungrouping of clinical and statistical groups of day-stay hospital was carried out depending on INN and dose of biologicals; patients with SA are selected for TT and included in the regional register. Initiating of TT in round-the-clock hospital and continuation therapy in day-stay hospital provides a significant savings in compulsory medical insurance funds. Conclusions: introduction of IBT for SA in SR is carried out within framework of developed program. Principle of decentralization brings highly specialized types of medical care closer to patients and makes it possible to provide routine medical care in allergology-immunology profile in context of restrictions caused by COVID-19 pandemic.

Download Full-text

Charter of the Kazan Society of Physicians for the provision of medical care to participants in the sickness funds established by law on June 3, 1912

Kazan medical journal ◽

10.17816/kazmj48887 ◽

1913 ◽

Vol 13 (2) ◽

pp. 91-110

Keyword(s):

Health Insurance ◽

Medical Care ◽

Insurance Fund ◽

Health Insurance Fund ◽

Medical Assistance ◽

Medical Aid ◽

Insurance Funds ◽

The Law ◽

Health Insurance Funds ◽

The City

The Kazan Society of Physicians for the Provision of Medical Aid to the Participants of the Health Insurance Funds Established on the Basis of the Law of June 23, 1912 "has the goal of providing medical assistance to the participants of the Health Insurance Fund established on the basis of the Law of June 23, 1912 in the city of Kazan and its environs.

Download Full-text