There are two main purposes to stipulate the total fund expenditure: one is to form a cost restraint mechanism for both doctors and insurance companies, so that social insurance agencies can do as many things as they want, so that designated medical institutions can know the payment ability and amount of social insurance agencies, thus improving the cost awareness of medical institutions and ensuring the balance of basic medical insurance funds. Second, it meets the requirements of basic medical insurance fund management. According to the principle of two lines of revenue and expenditure management, the basic medical insurance fund should establish a budget and final accounts system. According to the use budget of the basic medical insurance fund, it is inevitable to require social insurance agencies to have a total expenditure control index before spending. Without this total expenditure control, it is difficult to ensure the implementation of the fund budget.
Setting the quota control index of designated medical institutions is a necessary measure, and it is also an important means to clarify the respective responsibilities, powers and obligations of medical insurance institutions and medical service institutions in implementing basic medical insurance services and cost control, and to formulate a reasonable basis for cost settlement audit. Without the specific quantitative index of quota control, there is no basis for the audit of fee settlement, and it is difficult to define the scope of medical service disputes and fee payment.