Study On The Moral Hazard In The Social Medical Insurance And It's Control

Nowadays, one of the most important origin of the medical expense irrational rise is the moral hazard problem caused by defects in the medical insurance system. The problem not only sharply increases medical expenses, influences rational distribution of rare medical resources, but also causes great impact on the sustainable development of medical insurance system. Therefore, it is a subject with important theoretical significances and practical values to study the moral hazard problem and its control in the medical insurance.By reviewing the developing processes of the medical insurance systems and the moral hazard problems at home and abroad, the different manifestations with relevant reasons are analyzed in detail from three perspectives of medical service demander, the supplier and the insurance institution.Then, the deeper reasons respectively from the economics mechanism perspective and the game model theory are explained. At the same time, the research deeply discusses the influences caused by the moral hazard form the viewpopint of trust system.Based on the summary of the experience and methods of moral hazard control in the medical insurance both at home and abroad, the research explores the basic thoughts and the concrete strategies of controlling the moral hazard. At last, the research introduces some ways of establishing medical insurance reputation hierarchy and does efficacy analysis which aims at testing the rationality of the basic thoughts mentioned in the research.The innovation of this research mainly includes the following aspects:F irstly,according to the study of the trust mechanism in institutional economics and sociology, the research proposes social influences of the moral hazard. One aspect is the destruction of the trust of medical insurance system; the other is the destruction of the trust of the experts in this system. This analysis explains problems widely existing in medical area well such as the conflicts between doctors and patients nowadays.Secendly,the research designs the reputation system of moral hazard control, for example, establishing reputation achieves system of licensed physicians, evaluation system of reputation hierarchy of fixed medical institutions, social supervisory system of insurance institution, fund supervisory system of medical insurance. The research claims to set up insured patients'information achieves administrating system, and puts forward the brand-new assumption that the insured patients'information achieves mainly includes the health achieves and reputation achieves of the insured patients.Thirdly,the research puts forward some distinctive views of the medical system reform. For instance, the research proposes to reform hospital hierarchy evaluating system and doctors'title evaluation method i.e., the technical qualification hierarchy and technical title of medical institutions and medical staff are evaluated by the health guild, and the reputation hierarchy is evaluated by the medical institution service supplier.