Commercial Health Insurance, Adverse Selection Risk And Moral Risk Control Study

In recent years, with the development of social economy and theenhancement of people's income, people gradually think a lot of thehealth and risk insurance of themselves. On one hand, people improvetheir need of medical treatment greatly, because of the trend that peoplelive older and older, the change of disease list, the deterioration of theenvironment and the application of new medical equipment andtechnology, so that it cause the swift increase of the medical cost, moreand more people can't bear the more and more expensive medical costany longer. On the other hand, with the gradual deepening of the reformof the medical insurance rule, the situation of medical treat at publicexpense has been broken; the situation that the government supported themedical cost has been as the history. These all give a perfect opportunityto develop commercial medical insurance. In 2001, the result of thesurvey in six cities made by the consumer association of China shows that:percent 50.1 people consider that it is certain to purchase commercialinsurance and percent 29.9 think that it is in the 2 years to buycommercial insurance. In theses need, medical insurance has been as thehottest insurance sort that the people intend to buy, beyond the demand ofthe endowment insurance and life insurance. However, compare with thereal demand, the development of medical insurance at the present time isjust passable. Actually, many insurance companies are not eager to setfoot in commercial medical insurance and not willing to exploit the newproduct of medical insurance. Therefore, it emerges the awkwardsituation of so-called "hot out and cold in" in the field of commercialmedical insurance. What is the reason? The author thinks the mainreasons that block the development of medical insurance are the adverseselection and the moral hazard. The thesis points that the adverseselection and the moral hazard is the arch criminal that block thedevelopment of medical insurance, and analyzes and demonstrates howdo the adverse selection and the moral hazard come in being from theconception, characteristic and present difficulty of the commercialmedical insurance. Then, the paper supports some idiographic measuresand feasible plan to keep away the adverse selection and the moral hazardaim at the actual circumstances in china at present, through studying andanalyzing the advanced technology and scientific operational mode of theinsurance risk control in America. It is can be safely concluded that the industry have appeared higherand higher passion on the expansion of the commercial medical insurancefrom that some new medical insurance companies have been opened inthis year. But, because it is very professional that the medical insurance isand the correlative academic research is still behindhand,the authorhopes the paper can lead that more and more people in insurance field canpay more attention to the problem about the insurance risk control , andresearch and establish a perfect control system against the risk of theadverse selection and the moral hazard, and accelerate the healthydevelopment of the commercial medical insurance in our country. The thesis includes four parts in all: The first chapter draws forth the inconsistent relation among theinsurance company, the policy holder and the medical establishment fromanalyzing the particular connection about three participants in medicalinsurance based on medical insurance's conception and characteristic.Then, on the basement of describing the present situation about ourcountry's medical insurance, the author points the reasons that result inthe conflict between need and support in the insurance market is the riskof the adverse selection and the moral hazard in the commercial medicalinsurance. The outstanding effect aroused by the adverse selection and themoral hazard in the commercial medical insurance leads to the seriousdeficit on dealing in the business of the commercial medical insurance ininsurance company. The high loss ratio makes the insurance companydoes not dare to set foot in this dom...