The sources of funds for the medical insurance fund mainly include medical insurance premiums paid by individuals, government grants and social donations. These funds will be collected and used to pay the medical expenses of the insured, including hospitalization expenses, outpatient expenses and drug expenses.
The medical insurance fund usually operates by establishing a medical insurance system, bringing the medical expenses of the insured into unified management and allocating funds according to the payment and medical needs of the insured. The specific operation mode may vary from country to country.
The establishment and management of medical insurance fund need strict supervision and financial management system to ensure the rational use and safety of the fund. At the same time, the use of medical insurance funds also needs to be regulated according to relevant laws and regulations to prevent abuse and waste.
In a word, the medical insurance fund is an important social security system, which aims to provide basic medical security and economic support for the insured. Its establishment and management need the support and supervision of the government and relevant institutions to ensure the rational use of funds and protect people's health rights and interests.
The operation mechanism and management process of medical insurance fund involve many links. First of all, the sources of medical insurance funds mainly include individual contributions, government grants and other financing channels. These funds are pooled into the medical insurance fund pool to pay the medical expenses of the insured. Secondly, the medical insurance fund management institution is responsible for formulating relevant policies and regulations, supervising the use of funds, and conducting risk assessment and control. In addition, the medical insurance fund has established cooperative relations with medical institutions and pharmacies to settle expenses and manage medical services. The management process includes capital revenue and expenditure accounting, cost audit and medical service supervision. By establishing scientific operation mechanism and strict management process, medical insurance fund can better protect the medical rights and interests of insured persons and improve the quality and efficiency of medical services.
People's Republic of China (PRC) Social Insurance Law;
Chapter III Basic Medical Insurance
Twenty-sixth 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.