First, we should increase the collection efforts and ensure the collection rate of funds. In order to ensure the normal operation of the overall fund, we must ensure a high fund collection rate, and pay special attention to preventing malicious arrears.
the second is to establish and improve the basic medical insurance budget system and fund early warning system. Before the start of the overall planning year, we must budget the total income and expenditure of medical insurance funds in this overall planning year, especially the income and expenditure of the overall planning fund, and leave sufficient room. After the overall budget is completed, we will verify the specific income and expenditure budgets of individual accounts and overall planning funds respectively. Fund early warning system refers to the establishment of the basic medical insurance system, through the management information system, to set up corresponding warning lines for various funds, so as to warn the possible risks in the operation of the fund system in advance. For the integrated areas that have been networked, it is necessary to make full use of management information systems and computer settlement systems to implement online monitoring.
thirdly, we should determine the appropriate payment ratio in combination with the actual situation. Because the income level and medical consumption level vary greatly from place to place, we must adhere to the principle of seeking truth from facts, adapting to local conditions and analyzing specific problems in terms of payment ratio and payment method, and we must never completely copy the existing routines of so-called large and medium-sized cities and reform pilots.
the fourth is to establish the adjustment and balance mechanism of overall fund payment. Judging from the practice in various places, the overall fund mainly pays most of the hospitalization expenses of medical insurance patients and part of the expenses of special clinics. Usually, hospitalization expenses are paid in stages according to a certain proportion, but how to pay for special outpatient services varies from place to place, which is also an important part of establishing an adjustment mechanism. Outpatient special disease subsidies should adopt flexible proportion, that is, the specific proportion of subsidies should be determined according to the balance of the year-end overall fund.
Fifth, we should strictly examine the serious illness. The threshold setting and payment ratio of mutual aid for serious illness vary from place to place, but the number of people entering mutual aid for serious illness is increasing year by year, and the cost is increasing greatly. This has caused considerable payment pressure to medical insurance agencies.