Study on Basic Medical Insurance Fund Revenue and Expenditure Risk Early Warning System
Promoting the establishment of the social security fund revenue and expenditure risk warning system is helpful for improving the risk management of the fund and transforming the risk management from post-discovering risk and post-reducing loss to prior-wa
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Study on Basic Medical Insurance Fund Revenue and Expenditure Risk Early Warning System Yun Lu and Zhenzi Xu Abstract Promoting the establishment of the social security fund revenue and expenditure risk warning system is helpful for improving the risk management of the fund and transforming the risk management from post-discovering risk and post-reducing loss to prior-warning and prior-resolving risk. In this paper, by taking the urban labors basic medical insurances fund revenue and expenditure risk warning as a study point and referring to domestic and foreign literatures, the necessity, intension, principle, and warning indexes selection for the establishment of risk early warning system are analyzed and studied. On such a basis, a certain number of indexes are selected for preliminarily constructing a risk early warning system, and then risk early warning system solutions are proposed. Keywords Basic medical insurances fund • Revenue and expenditure risk • Risk early warning system
101.1 Introduction The stable operation of social security fund can’t be realized without mature risk early warning system as support. In this paper, the fund revenue and expenditure risk early warning system for the basic medical insurance of urban labors is only explored and studied. In the 1980s, a medical insurance risk early warning system was established in Germany; a medical insurance commission model was established in Australia. In addition, local government medical insurance model and the budget model of the ministry of health were designed by the World Health Organization. In recent years, there is also a certain development in this aspect in China, such as the research model of unemployment insurance fund revenue and expenditure monitoring established by the institute of social security of the Ministry of Human Resource and Social Security of the People’s Republic of China, and Y. Lu (*) · Z. Xu Department of Insurances, School of Public Health, Southeast University, Nanjing 210096, China e-mail: [email protected] W. Du (ed.), Informatics and Management Science I, Lecture Notes in Electrical Engineering 204, DOI: 10.1007/978-1-4471-4802-9_101, © Springer-Verlag London 2013
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Nanjing medical insurances fund revenue and expenditure risk early monitoring and warning system. So far, many studies have focused on the single factor qualitative analysis of health care or disease cost. However, quantitative analyses on the factors influencing fund revenue and expenditure risks are insufficient, and have affected the systemic studies and software development to some extent [1, 2].
101.2 Necessity for Establishing the Basic Medical Insurance Fund Revenue and Expenditure Risk Early Warning System of Urban Labors Since 2001, the basic medical insurance system of urban labors has been promoted all over the country; its coverage and fund scale are unceasingly expanded, and also the fund runs stably [3]. However, in recent years, because of the problems such as hiding social insurance base, unreasonable
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