Medical insurance pooling refers to the remaining portion of the medical insurance premiums paid by all employers in a certain pooling area for their employees after deducting them and transferring them to individual accounts.

The medical insurance overall fund belongs to all insured persons, is centrally managed by social insurance agencies, and is uniformly allocated and used. It is mainly used to pay medical expenses, surgical expenses, nursing expenses, basic examination fees, etc. incurred by insured employees.

The medical insurance pooling fund shall be stored and used exclusively for special purposes, and shall not be misappropriated by any unit or individual.

The overall planning fund includes: the remainder after deducting the total payment of all insured units in the overall planning area and crediting it to individual accounts; financial subsidies; social donations; bank interest; late payment fees, etc.

The medical insurance pooling fund belongs to all insured persons and is stored and used exclusively for special purposes. No unit or individual may misappropriate it.

The overall fund is mainly used for medical expenses such as hospitalization of insured persons, emergency rescue in non-designated hospitals, off-site referral (hospital), off-site placement, and special disease outpatient services.

Risk prevention of the medical insurance pooling fund The medical insurance pooling fund is the primary condition for ensuring the normal operation of the basic medical insurance system.

Once there is a serious overspending of the overall pool fund, the protection function of the basic medical insurance system will be weakened or even collapse, leading to the failure of the basic medical insurance reform.

However, the overall fund faces various risks during its operation, which is an objective fact that cannot be avoided.

Therefore, it is of great practical significance to carefully study and discuss various risks existing in the operation of medical insurance funds and to avoid and prevent these risks.

1. The formation of risks In the current social environment, the formation of medical insurance pooling fund risks can be roughly divided into overall social factors and local social factors.

The overall social factors mainly include the following points: First, it is due to the characteristics of my country’s medical insurance system.

my country's existing medical insurance system is gradually transformed from the previous publicly funded medical care.

At this stage, the payment of medical insurance is completed by three aspects: insured persons, medical institutions and medical insurance agencies. The opacity of medical consumption makes it difficult for medical regulatory agencies to reasonably determine the value of medical consumption and the content of consumption.

It is difficult to accurately define the nature of medical expenses, which makes it difficult for the overall fund to pay medical expenses normally and accurately.

Second, under the current situation, the financial investment received by designated medical institutions remains unchanged or even reduced, and their economic benefits mainly rely on their own revenue-generating capabilities. This inevitably makes medical institutions regard obtaining economic benefits as an extremely important priority.

In pursuit of goals, some medical institutions even resort to various means in order to obtain maximum economic benefits. The Harbin sky-high medical expense incident that caused a stir some time ago is the best example.

Third, as medical and health conditions improve, the problem of population aging becomes more and more prominent, and the medical consumption needs of this group of people are also increasing, which will inevitably lead to a substantial increase in medical expenses.

Some social factors that cause fund risks include: First, the collection of insurance funds is greatly affected by the economic situation.

Under the current market economic conditions and social environment, in areas with relatively backward economic foundations, a considerable number of units cannot pay medical insurance for their employees in full and on time within the prescribed period, and the insured employees of these units still have to undergo medical treatment.

consumption, which will result in a significant reduction in the overall pool fund.

Second, with the development of medical technology, new medical equipment is continuously put into clinical application. Due to the psychology of the patients, they all hope to use the latest and best medical equipment as much as possible, resulting in a significant increase in per capita medical expenses, which will also

Increase the expenditure of the unified fund.

At present, my country's medical insurance co-ordination is basically based on counties and districts, operating independently, and it is temporarily impossible to establish an overall coordination and balance mechanism.

2. Fund Raising and Expenditure Raising and disbursing are the two keys to ensuring the safe and normal operation of the fund. Fund raising is the basis for the operation of the medical security system. Only when the required funds are raised in full and on time can the normal operation of the system be guaranteed.

The proportion of funds raised is based on local living and medical consumption levels, and future development trends must also be taken into consideration. Therefore, when determining the level of co-ordination, careful investigation and analysis must be carried out to be accurate and appropriate.

Under normal circumstances, the financing level should be slightly higher than the level of medical consumption, achieving a slight surplus.

If mistakes or poor analysis are made in the investigation and analysis, or future medical cost trends cannot be accurately predicted, and the financing level is lower than the predetermined medical consumption level, the fund operation may be at risk of overdraft.

Fund payment methods can be roughly divided into three types based on the cities that have implemented the basic medical insurance system: 1. Patients pay directly to the hospital when they see a doctor, and then the patient settles with the medical insurance institution; 2. Patients do not pay directly when they see a doctor.

, the hospital and the medical insurance institution make mutual settlements; 3. The medical insurance institution and the hospital adopt fixed budget management, and the medical insurance institution allocates medical expenses on a monthly basis and makes a final settlement at the end of the year.