The medical insurance pooling fund belongs to all insured persons, and is managed centrally by social insurance agencies and used uniformly. It is mainly used to pay the medical expenses, operation expenses, nursing expenses and basic inspection expenses of the insured employees. The medical insurance fund shall be stored in a special account for special purposes, and no unit or individual may misappropriate it.
The total payment of all insured units in the overall planning area, after deducting the remaining part recorded in personal accounts, financial subsidies, social donations, bank interest, late fees, etc. The medical insurance pooling fund is the primary condition to ensure the normal operation of the basic medical insurance system. Once the overall fund is seriously overspent, the protection function of the basic medical insurance system will weaken or even collapse.
Measures to resolve the risks of medical insurance pooling fund system;
It is necessary to adjust the relevant proportional standards in a timely manner. When the amount of overspending is huge and the overspending expenses are within the normal and reasonable expenditure range, it is not caused by illegal or excessive medical consumption. In this case, we can consider increasing the collection ratio appropriately to increase the total amount of the overall fund and improve the payment ability of the overall fund.
It is necessary to establish a fund reservation system, strive for more government funds, and achieve the purpose of sharing risks. The fund reservation system is to reserve a certain proportion of funds from the settlement amount of each designated medical institution to restrain the illegal activities of each designated medical institution. At the same time, a reward system can be established to reward and commend the designated medical institutions with outstanding performance in various forms.