Study On The Collusive Insurance Fraud Of The Insured And The Service Provider

Insurance Fraud is an old and youthful issue. The battle between the insurance industry and insurance fraud is eternal. The academic circles have started to concern the issue since the 1970's, and launched in-depth research with the rise of information economics and information technology. The collusive insurance fraud of the insured and providers jeopardizes the insurance industry because it's hard to be detected and it has high success rate. The contemporary research needs further actions, such as re-modulating the game model to fit the status quo of insurance business, extending the research of the provider from the present focus of health insurance, and studying the consumers'attitude toward insurance fraud in local market.The dissertation studies the optimal anti-fraud insurance contract design, the affiliation of the insurers and providers as well as the consumers'attitudes in local insurance market.The optimal anti-fraud insurance contract has the following characters. It provides over-insurance to high loss and under-insurance to low loss. The difference of the indemnities is a new way to ameliorate the insured's fraudulent behavior. It also has a deterrence mechanism as auditing. The higher the success ratio of audit, the lower the premium and the higher the difference of the indemnities. This, in turn, will enhance the attractiveness of the insurance contract and constrain the fraudulent behavior of the insured.The exclusive affiliation of the insurer and the provider can reduce the fraudulent behavior of the provider. The insurer should abandon the notion of ignoring the management towards the provider for excessive emphasis on the turnover and price-competition. The insurer could consider up-stream integration toward provider.The domestic customers are more tolerative to insurance fraud, and the influence factors are much different from that of foreign studies. Income, morality and the attitude towards fraud-controlling are three factors in domestic study with statistic meaning. The experience of insurance consuming has no statistical meaning in this study. Especially, the customers have almost the same attitude to insurance fraud no matter he trusts the insurer or not.Suggestions of controlling insurance fraud are given according the study.