The Research On The Moral Hazard Control Of Commercial Medical Insurance

The reformation of the medical insurance system of China in 1990s brings unprecedented opportunities for commercial medical insurance. Developing commercial medical insurance will have great significance, but because of the existence of asymmetric information in the field of medical insurance, the harm of moral hazard has become an important factor which restricts the development of the professional work. Compared with other types of insurance, medical insurance has an outstanding character, which is the market of medical insurance involves the insured, the medical provider and the insurance company. The existence of medical provider makes the relationships between them more complicated, so the moral hazard in medical insurance has its own specialties. The thesis first evaluates the concepts concerned of moral hazard, according to its microcosmic expression, the thesis then divides the moral hazard of medical insurance into the demand-side moral hazard and the supply-side moral hazard. The thesis considers that the expressions of the moral hazard of demander are the appearance which the insured alter their ideas and behaviors, the excessive medical consumption and the fraudulent conduct of the insured. The expressions of the moral hazard of provider are the excessive medical supply and the insufficient medical supply etc.In order to make a deep study of the emergent mechanism of moral hazard in the medical insurance market and take effective measures to control moral hazard, the thesis uses Game Theory as a tool and further analyses the behaviors between the insured and the insurance company, between the medical provider and the insurance company. It concludes that the insurance company should increase the punishment if the insured and medical providers break off their engagement, and should enhance their risk management level.Based on the analysis above, the thesis builds some models and puts forward a conception about the mechanism of the moral hazard control from two sides. The moral hazard of demander can be evaded by means of contract design, underwriting and claiming, the moral hazard of provider can be evaded by means of the reformation of the medical insurance payment, the rationalization examination of medical service and the integration of medical treatment and medical insurance. The thesis considers that the application of the encouragement-restraint mechanism is able to solve the problems of moral hazard which are caused by asymmetric information. The specific tactics above are the reflection of this ideology.At last, the thesis fully considers the particularities of commercial medical insurance and analyses their relationships between the specialized management and the controls of moral hazard through constructing the specialized management system. It detailed expounds how to control the moral hazard of commercial medical insurance...