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Discussion on railway construction enterprise participates in the medical insurance management model

Author: FengYuQiang From: www.yourpaper.net Posted: 2010-06-08 03:36:58 Read:
Abstract: This paper to the enterprise present medical insurance management pattern were summarized, discusses the feasibility and problems of different staff insurance, puts forward suggestions and measures.
Keywords: enterprise; medical insurance; management mode of
Abstract: The article carries on the summary to the enterprise present medical insurance management pattern, discusses feasibility which and existence question the different staff insures, gives the improvement comment and the measure.

Key words: enterprise; medical insurance; management pattern; discussion

Railway construction enterprises as a special medical insurance group, has a staff of highly mobile, decentralized, at length, branch organizations and workers throughout the country.In the current medical insurance policy can not achieve the overall situation, can only choose the place of registration of insurance in the enterprise, resulting in more than 60% people is territorial (local) insurance, medical treatment, remote (field) has certain particularity in the fund collection, selection, medical institutions designated medical expense settlement, the personal account fund management etc. hand.The company vigorously support the local health center, from 2001 to December, nearly 6000 employees unified participates in the municipal medical insurance as a whole, through years of practice, and explore a set of effective management mode, accumulated certain experience, in the basic medical security requirements of the enterprise workers at the same time, also and provides reference basis for enterprises of the same nature of insurance.
1 the current management mode of
1.1 medical insurance work to start the
One is the research and effective communication is the key to determine the insurance.In view of the special nature of railway construction enterprise, in deciding whether to participate and how to participate in the process, first of all, to do a good job of investigation and analysis.The two is the policy explanation and propaganda is the mass basis of Medicare smooth operation.Medical insurance to participate in local planning, beneficiaries and participants directly are broad worker masses, so do a good job of propaganda and mobilization work necessary.Three is the start-up capital and basic data is necessary to prepare the work.The insured at the beginning of the start-up capital including prepaid health insurance fund and handling card, card, and other expenditure fee.Can give the solution enterprise own funds or use assessed by each basic unit form, to be working in normal operation, supplemented by the grass-roots unit and individual pay money.
The 1.2 designated medical institutions of the selection and management of
Through effective communication, local health center for maximum support, provide convenience for medical workers.The specific measures are: one is the construction of the remote hospitals widely applicable to all staff.Considering the particularity of construction unit of flow construction, local health center allows us in every construction site selection two at or above the county level medical institutions as the construction location of the designated hospitals, health centers reported record.Two is the resident of different staff choose the nearest designated medical institutions and convenient medical treatment.Three is the territory of fixed-point medical institutions apply to all insured workers.
1.3 of the medical insurance fund collection
Medical insurance fund collection points for individuals and businesses to the two part, taking into account the construction enterprise basic unit staff special mobility frequent, in fund collection on our interior also took flexible measures.
(1) difference between the collection of personal funds.In accordance with the personnel command, regular and territorial health center database synchronization change basic medical insurance content, the staff is divided into local and remote management, personal fund levy on distinction.
(2) regular collection of enterprise fund.As with personal funds collection cycle, quarterly calculates the grass-roots units of the enterprise shall pay the fund, to notify each basic unit to the financial departments according to the provisions of the time.
(3) on time to the medical insurance fund.According to the local health center issued the "bill", the financial sector will be more personal and enterprise should be paid to the fund were integrated, and then open the check, by the enterprise business organizers turned over to the local health center on a monthly basis within the prescribed time limit.
1.4 medical expenses and clearing of
(1) the territorial hospital direct settlement.Local workers and foreign workers can seek medical treatment in the local medical institutions designated by the health insurance IC card, and a direct billing and medical institutions, do not involve expenses.
(2) remote hospital reimbursement to advance after.While the staff in different medical institutions selected hospitalized, the call report within 5 days to the business sector, by agency staff to report to the local health center, charge by individual to advance, to medical care after the end of the paper, medical expenses, medication list, order and relevant inspection copy of enterprise managers department, business department in charge of centralized declaration at the beginning of each month to the health care center, by the health center after the audit, the reimbursement payments to return to the enterprise, the enterprise again issued to individual workers.1.5 the individual account fund management
(1) the local worker individual account gold directly into health insurance IC card.By the local health center, according to the different age categories specified proportion, monthly account insurance individual local workers Health Insurance IC card payments into individual, for outpatient service, drugstore to buy medicines and pay for hospital treatment should be part of the burden of personal.
(2) different staff personal accounts regularly in the form of cash return.Provisions of local health center policy, different staff personal accounts do not enter the individual health insurance IC card, each half centralized transfer into enterprise accounts, by enterprises to individuals.In remote processing worker individual account gold issues, service workers and retired workers differently.This method overcomes the disadvantages resulted from the frequent flow of workers, avoids the workers to complex and not levy personal fund and the payment of personal insurance gold, reducing the error occurred.
1.6 medical insurance operation daily management of
A business person responsible for the staff in the work of medical insurance.Two cases of different staff, health insurance IC card is the centralized management.Because the medical insurance has not yet to achieve national co-ordination, the health insurance IC card is only applicable to medical institutions in the local, remote workers medical insurance personal accounts gold and not included in Health Insurance IC card I, we take the employees health insurance IC card and case book issued to me, convenient employee medical treatment.The three is timely and reasonable medical guidance is crucial to the workers.According to the different staff accounted for a large proportion, the personnel must be familiar with the relevant policies and regulations, accept the staff by telephone, letter consultation, to answer their questions about in the course of medical treatment, to guide all insured workers reasonable medical treatment, the treatment to fully enjoy the health care, the most greatly reduce the economic burden of employees.
2 problems found in
2.1 different medical workers personal expense ratio of high
According to statistics, the company in recent years while hospitalized, individual workers per capita expense to total health care costs were higher than 37.72%~44.85%, the State Council promulgated the "on the establishment of the basic medical insurance system for urban workers decided to" the personal overall medical expense burden level should be controlled at about 20% of the overall goal.The reasons for this situation there are several major aspects: regional differences of medical insurance policy to co-ordinate the project difference [1] [3]; insurance and medical insurance management institutions can't medical institutions in different places to achieve effective supervision and management, there are some overtreatment phenomenon; the different staff information relatively occlusion, the medical insurance policy understanding insufficiency, caused by artificially increasing the personal expense.
2.2 different medical advance medical expenses so that employees and economic burden of
Railway construction enterprise workers, especially retired workers, personal income level are relatively limited, once in while hospitalized, little criterion thousands, many tens of thousands of medical expenses need to advance, the serious condition of the worker is a heavy burden.
2.3 reimbursement program complexity increase
The medical staff fear [2]

Due to different medical staff medical costs cannot direct settlement, need to be medical care after the end for a series of procedures, and report to the local health center for audit and the reimbursement procedures complicated, with no medical knowledge workers is not a simple matter.Plus some remote medical institutions can not provide these procedures actively, set up artificial barriers, often need to repeatedly to achieve the reported to the health center requirement, this increase in staff's fear of difficulty, affects the treatment implement.
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