Study On Prevention Mechanism Of Moral Hazard In Shanghai Medical Insurance Based On Economic Man Theory

Medical insurance in our country is an important part of social securitysystem, the supply of medical service and the rational use of medicalinsurance fund are related to each participant interests. However, Inducedconsumption, excessive medical and other forms of moral hazard are commonand serious, because of the medical service all parties to pursue their ownbenefit maximization, information asymmetry in the medical market, thelimitation of the medical insurance system and so on. This problem notonly sharply increases medical expenses, influences rationaldistribution of rare medical resources, but also causes great impact on thesustainable development of medical insurance system. Therefore, it is asubject with important theoretical significances and practical values to studythe moral hazard problem and its control in the medical insurance.According to its different severity, this paper makes a detaileddescription and analysis of the different manifestations on the moral hazard inShanghai medical insurance, from three perspectives of medical servicedemander, the supplier and the insurance institution. On basis of the theory of,the deeper reasons of moral hazard are explained from three perspectives: all parties are "economic man" to pursue their own benefit maximization,"economic man" negative effects are magnified because of special medicalindustry, institutional constraints to "economic man" is insufficient.This paper mainly take the literature research, case and the comparativestudy. On basis of "economic man" theory, the research explores the concretestrategies of moral risk evasion such as incentive mechanism and institutionalconstraints, by using overseas experiences and combining with the actualcircumstances in Shanghai. Prevention for the supplier moral hazard asfollows: the separation of the medical and medicine, improve medicalinsurance fee payment, establish the medical service information sharingmechanism, strengthen the supervision and establish a scientific system ofrewards and penalties, form the medical market reputation mechanism.Prevention for the buyer moral hazard as follows: to establish an effectiveclassification referral system, a family account avoid insurane cardcombination phenomenon, build patients information file management system.Prevention for moral hazard of medical insurance institutions as follows: tostrengthen internal supervision, establish a social supervision and evaluationsystem, enhance staff training and education thought.This paper will providecertain theoretical and practical reference for medical insurance moral riskprevention and management.