It is imperative to plan ahead and nip in the bud the risks of pooling funds, and carefully study and explore measures and methods to resolve risks. Only in this way can we ensure the normal operation of the medical insurance system. There are usually the following measures to resolve risks:
First, we should seize the opportunity and try our best to resolve risks in the bud. The risk of pooling funds usually means that the payment amount of pooling funds exceeds the account amount of pooling funds. This kind of overspending often occurs gradually, which can be reflected by monthly statistical reports. Therefore, we should standardize the accounting statistical report system, carefully check the monthly income and expenditure situation, and adjust it immediately in the next month in case of overspending, so as to solve the problem of overspending as far as possible in the overall year; If there is a serious over-expenditure in the year-end summary of the overall planning year, it must be solved in the first quarter of the new overall planning year.
second, we should adjust the relevant proportional standards in a timely and appropriate manner. When the amount of overspending is huge, and the overspending expenses are within the normal and reasonable expenditure range, which is not caused by violation of regulations or excessive medical consumption, in this case, we can consider increasing the collection ratio appropriately, so as to increase the total amount of the overall fund and improve the payment ability of the overall fund, but the proportion included in the personal account can not be reduced generally, otherwise, it will easily lead to the psychological imbalance of the insured. In addition, the collection base and payment ratio of mutual aid for serious illness can be adjusted appropriately according to the situation to relieve the payment pressure of mutual aid for serious illness. If the above measures still can't solve the risk, it is necessary to raise the minimum payment standard of the overall fund payment items or reduce the payment proportion of the overall fund, so as to enhance the saving consciousness of the insured and moderately reduce the overall medical consumption level, thus solving the risk of overspending of the overall fund.
Third, it is necessary to establish a fund reservation system and strive for more government funds to achieve the purpose of sharing risks. The fund reservation system is to set aside a certain proportion of funds from the settlement amount of each designated medical institution to restrain the illegal behavior of each designated medical institution. At the same time, it can also establish a reward system, and adopt various forms of rewards and recognition for the outstanding designated medical institutions to promote their legal operation. In areas with developed economic level and sufficient financial resources, you can apply for the government to increase investment in social security and provide better social security services for the insured.