Abstract
This study is mainly based on the auditing of medical insurance funds in the audit work report of the National Audit Office’s 2019 central and provincial and municipal budget implementation and other fiscal revenues and expenditures to conduct audit supervision of China’s medical insurance funds, based on the risk-oriented violation of regulations. Identify and evaluate the risks of each stage of the medical insurance fund from the perspective of risk of breaches, thus draw audit points, summarize the path of the medical insurance fund audit supervision so that that audit resources can be concentrated in important stages and key areas. Audit costs can be reduced, and build the regulatory system of the medical insurance fund audit will be constructed accordingly.
Highlights
In recent years, China’s demand for social security has been increasing with social and economic development
We summarize and analyze the main issues disclosed in the audit of the medical insurance fund in the 2019 audit work report released by the audit offices of 15 Chinese provinces and municipalities according to the stage of violation
Only the provinces and cities involving the largest number of violations or the largest number of people can be identified as key areas for audit supervision if the probability of violation stage is small, which may still correspond to a large number of illegal funds, which usually occurs in the medical insurance embezzlement stage and the medical insurance reimbursement stage
Summary
China’s demand for social security has been increasing with social and economic development. With the rapid advancement of China’s medical insurance system, the Chinese government has made breakthroughs in operation and implementation of medical insurance and the management and use of medical insurance funds. To ensure the safe and standard operation of medical insurance funds, China must strengthen the audit supervision of medical insurance funds. We analyze the contents of the medical insurance fund audit in the “2019 Budget Execution and Other Financial Revenue and Expenditure Audit Work Report” issued by the Central Government and the Audit Office of 15 provinces and cities to clarify the key subjects and key stages of the medical insurance fund supervision and construct a path for medical insurance fund violation risk assessment and audit supervision. Based on clarifying the audit’s focus, an audit supervision system for the medical insurance fund was constructed
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