Challenges and Reflections on Fund Management Posed by the Medical Behavior of Insured Individuals

Abstract

Through analyzing the reasons why insured individuals' medical behavior poses challenges to the management of medical insurance fund, the following problems were found: significant differences in medical insurance benefits among different regions and insured identities, lack of information sharing platforms across multiple departments and regions, insufficient regulatory capacity of the medical insurance fund, limited public awareness of medical insurance policies and fraudulent behavior, and the increasingly serious phenomenon of health anxiety. In response to the above reasons, the following measures are proposed: promoting provincial-level coordination of medical insurance, improving the management of medical insurance catalog, accelerating the digitalization of medical insurance, enhancing the supervision ability of medical insurance fund, strengthening the promotion of insurance policies, and alleviating public health anxiety. These measures aim to increase insured individuals' awareness of protecting the medical insurance fund and foster collaboration between insurance management departments and medical institutions to ensure the fund's sustainable development.

Keywords

• insured individuals
• medical behavior
• management of medical insurance fund
• insurance fraud