The Appearance And Management Of Moral Hazard In The Social Medical Insurance

Social medical insurance is the most important part of the society guarantee system, medical service relates to the benefits of each citizen.The current social medical insurance system, is playing the active role in the aspects of guaranteeing the health of the people and scattering the disease risk.But the social medical insurance system is still a new policy, so there are some serious system blemish in it, lead to a great deal moral hazard problem in the medical market, obstruct the normal movement of medical insurance system, influence the normal operation of social medical insurance fund.Because of the dual economic structure, the social medical insurance system is be divided into the town medical insurance system and the village medical insurance system.The town medical insurance system experienced the reform of several stages, at first the town medical insurance system is public-fund medical insurance and labor protection insurance medical system, the people who having the medical insurance and his family memberseses can enjoy completely free or dirt cheap medical treatment service, resulted in a great deal of waste of medical resources.With the development and of the economy, many city and regions all carried on reform to the public-fund medical treatment and the labor insurance medical treatment according to the circumstance of oneself, the most famous is "liang-jiang reform".The reforms of village social medical insurance system is later, and the progress is also more slow, the government began to promote NCMS in the village since 1998, the new social medical insurance system of village starts building up.In the new social medical insurance system, people who paid certain insurance expenses all can enjoy a certain amount of social medical services, because of the co-payment systerm, the moral hazard be controled in some extent.But the mew social medical insurance system has never solved the moral hazard of supply side.Because of the market reform and the shortage of government the public finance in medical, the public-spirited property of hospital is gradually eroded by the economic benefits, for the sake of the development of oneself and the renewal of the technique and equipments, the medical organization continuously seizes the sufferer's benefits and opens big prescription, and has an otiose check, and make to cure to suffer from relating to nervous, cure to suffer from an antinomy to deepen, the sufferer lost the trust to the doctor and the medical organization.On the other hand, because of purchasing medical insurance the sufferer's buget is relax, produced the subjective wishes of excesssive con sumption. So produced to cure to suffer from the phenomenon that matches to strive for, decomposition prescription, the phenomenon that artificial hospitalization multifarious emergence, sufferer and medical organization conspire to take of the medical insurance fund, on the other hand a great deal of social medical resources being wasted, also seriously threaten the balanced budget of fund.The morals hazard is also called immoral behavior, there isn't an unified definition to the morals hazard currently, the definition of morals hazard in this article is because of the information dissymmetry, individual cause the negative externalities while maximizing his own benifit. At medical market, the morals hazard is divided into a need side morals hazard and supply side morals hazard and the matching of strive.Supply side morals hazardmainly performance as excesssive check, excessively use of medicine, and raise drugs price etc.;Need side morals hazard's mainly expressing is excesssive diagnosis and treatment and excessively prescribe a medicine, a ginseng protects, the whole family takes medicine etc.;Two match to strive of morals hazard mainly performance as, resolve prescription, with medicine string medicine with artificial hospitalization etc..Because the insurance joins and makes there are more choices in choosing strategy, were also provide certain system foundation creation and existence for morals risk.We did a investigation in three 3-class first grade hospitals, can know that the joining of medical insurance has the bigger influence on medical expense:In distributing age, the sufferer who do not have the medical insurance is to scatter more, and younger, hospitalized sufferer who in insurance's the total expenses of set is more obviously high than the one who don't have insurance, and the difference of the two is obvious;Be constituting each expenses the last western medicine fee and check a fee, other fees and bed fee, cure a fee, nursing fee the insuranced set is aller obviously high than not insuranced set, and the difference of the two is obvious;Surgical operation expenses is constitute to go to hospital expenses of mainly constitute part, at the same time the surgical operation can influence the sufferer's hospitalized day and the amount of medicines, so whether had an operation to become to the most important factor of influencng a sufferer's expenses.At the operation set, insuranced sufferer's western medicine fee, check fee and bed fee, other feeses is aller obviously high than the not insuranced one; The insuranced sufferer also have higher hospitalized day, also consumed more medical resourceses at the same time, this phenomenon is particularly obvious in the chronic disease and the complicated disease case. The result is consistent with the Rand experiment, the sufferer not in the medical insurance will use less resources than the sufferer in insurance, the hospitalized day of the insuranced one is longer than the one who is not;Sufferer's medical expense that takes part in the insurance at the same time expends more obviously high than the one who is not in the insurance, co-payment system have many important influence to personal behavior choice.While carrying on a game, as a rational economic person, the strategy between need side and supply side is(cooperative,uncooperative), the strategy of insurance organization is(examine, unexamine).We got some useful results after be splited to many simple gamesr:Is the cost that the insurance organization examines is smaller than to insurance organization it doesn't examine but be subjected to of result in because of additionally make false report medical expenses of loss, the insurance organization then will definitely choose to examine strategy.The game balanced strategy of the sufferer and insurance organization brings trouble to choose to be unsuited to cooperative the insurance organization chooses not to examine.The game result of sufferer and medical organization is a hybrid game result, according to the strength for punishment is different and different from the difference in amount that matches an of striving for the income.If the enlargement matches the punishment of striving for the behavior to the sufferer, although the behavior that will repress to match to cooperative in the short run,in a long period of time can increase medical organization to match to strive for of all rate, can not improve to match the problem for striving for.If the insurance organization enlargement matches the punishment for striving for to the medical organization, it will make medical organization choose uncooperative for strategy in the short date, and the long term will also reduce a sufferer to match cooperative.On the foundation of game model, we use of the CTAM model, and respectively establishment provide side and need side morals hazard control model, can know:the ratio of co-payment of personal paying is just related with the need, the rate is high, person need paying expenses more, the totally paying proportion can repress an individual excessively consume, lower need side's morals hazard;the insurance organization can set a medical expense x, if x appear more at low level, the medical organization gets down adjustment in the x income;Whereas, then adjust upward.Under the circumstance of information dissymmetry, the insurance organization predicts if the medical organization makes great effort to control expenses and then carries on a prize or punishment to the medical organization according to the sufferer's medical expense x prognosticated.If then adopt to punish measure for low effort level, if then adopt to praise measure for high effort level, so can availably control supply square's morals risk.The use of this theory conclusion in practice applying express to adopt constitution to pay line and the tallest quota to the square of need, for supply side then tradition way of pay be changed as advancement system, through the changing of the paying the way to limit the supply and demand sides' morals hazadr.At the same time to complete our country social medical insurance system is the indemnification of these measures.