Analyzing The Dilemmas And Solutions In China's Social Health Insurance

At the background of new health care reform,China's social health insurance(SHI) is in an unprecedented development period,but the problems of asymmetric information,including adverse selection and moral hazard, have formed a tremendous obstacle to the further development of SHI.This study described the basic theories of SHI ,asymmetric information,and principal-agent theory, analyzed the models of adverse selection and moral hazard in SHI, the mechanisms of asymmetric information are as follows:1) the basic cause of asymmetric information is different actors sharing different private information;2) according to the order of time,the model of asymmetric information game in advance is called adverse selection model,on the contrary,the model after the event is called moral hazard model.Adverse selection under asymmetric information has a direct affecttion on the improvement of SHI coverage,also leads to a large proportion of high risk persons in all insured population,the manifestations are:1)high insured rate of elderly population;2)low insured rate of migrant workers; 3) the poor "subsidied" the rich in insurance; 4) the rates of different occupations were significant difference;5) the weak laws did not ensure "wide coverage"; 6) adverse selection was under the difference of treatment between health insurance systems.Moral hazard under asymmetric information damaged the development of SHI and promoted the sharp rise in health costs,the growth of per capita health expenditure was more than the per capita GDP,moral hazard can be expressed as: 1)insured excess demand to achieve a high insured amount of compensation; 2)supplier-induced demand to enhance the level of additional revenue; 3)doctor-patient collusion for their common interests; 4)insurer bad faith to grab funding.Based on the empirical survey in Guangzhou SHI, confirmed asymmetric information damage. It caused by adverse selection under asymmetric information and the moral hazard behaviors of supplier and insured mainly in:1)adverse selection obstructed the process of universal health coverage; 2) doctor's moral hazard was the main cause of health care costs rising; 3) the self-interest behavior of some patients harmed the overall interests of SHI.This study has important reference to other areas analysis of SHI implementation.Summarized the preventing experiences of other countries,China needs to focus on two innovation mechanisms of shared responsibility and benefits of incentives with practice.The measures to prevent asymmetric information in SHI including: 1)strengthening relevant legislation and promoting the treatment equity between SHI systems,to expand the coverage; 2)setting fair deductibles and flexible coinsurance,narrowing the policy limits,to determine a reasonable patient's cost-sharing mechanisms; 3) implementing prepaid payment system, including, exploring capitation in community-based health center, implementating DRGs in the hospital, using various forms of prepayment; 4)improving SHI fund supervision and information disclosure,such as,achieving the fund accounting full and timely collection,guaranteeing SHI fund expenditures meet the compensation requirements,establishing a long-term effective mechanism for information disclosure; 5 ) promoting commercial health insurance to play a positive role,innovating supplementary medical insurance products, involving in handling services.