Medical pooling funds belong to all insured persons and are managed and used by social insurance agencies in a unified way. Insured employees can be used to pay medical expenses, operation expenses, nursing expenses, basic inspection fees, etc.
In the current social environment, the formation of medical insurance pooling fund risk can be roughly divided into overall social factors and local social factors.
The overall social factors mainly include the following points:
1 is caused by the characteristics of China's medical insurance system. The existing medical insurance system in China is gradually transformed from the original public medical care. At this stage, 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 supervision institutions to accurately define the value of medical consumption and the rationality of consumption content, which makes it very difficult for the overall fund to pay medical expenses normally and accurately.
2. Under the current situation, the financial investment of designated medical institutions is unchanged or even reduced, and its economic benefits mainly depend on its own income-generating ability, which inevitably makes medical institutions regard obtaining economic benefits as an extremely important pursuit goal, and even some medical institutions do not hesitate to take various measures to obtain the maximum economic benefits. The recent uproar in Harbin's sky-high medical expenses is the best example;
3. With the strengthening of medical and health conditions, the problem of aging population is becoming increasingly prominent, and the medical consumption demand of this group of people is also increasing day by day, which will inevitably lead to a substantial increase in medical expenses.
Detailed rules for the implementation of the regulations on the administration of medical institutions
Sixth medical institutions engaged in medical activities according to law, protected by law. Article 88 The meanings of the following terms in the Regulations and the first paragraph of these Rules:
Diagnosis and treatment activities refer to the activities of judging and eliminating diseases, relieving illness, relieving pain, improving function, prolonging life and helping patients recover health through various examinations, using drugs, instruments and surgery.