Legal analysis: In the current social environment, the formation of risks of medical insurance pooling funds can be roughly divided into overall social factors and local social factors. China's medical insurance system is caused by its own characteristics. China's existing medical insurance system is gradually transformed from the previous public medical care. At present, the payment of medical insurance is completed by the insured, medical institutions and medical insurance agencies. The opacity of medical consumption makes it difficult for medical regulatory agencies to accurately define the value of medical consumption and the rationality of consumption content, which has caused great difficulties for pooling funds to pay medical expenses normally and accurately.

legal basis: social insurance law of the people's Republic of China

article 2 the state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance to protect citizens' right to get material help from the state and society in case of old age, illness, industrial injury, unemployment and maternity.

article 26 the treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

article 28 medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.