Research On Moral Hazard And Its Prevention & Control Of Social Medical Insurance In Wuhu City

In recent years, the issue of moral hazard in social medical insurance was frequently reported and covered via various medias, which attracted public general concern of the whole society. These immoral behaviors had seriously eroded social insurance fund, doing harm to the justice of medical security system and preventing the smooth operation of medical insurance system. Therefore, effective control and constraint on moral hazard are essential to safeguard medical fund safety and maintain benign operation of the system. However, due to the highly professionalness of medical treatment, heterogenicity and demand elasticity of medical service, and high asymmetry of medical information, the behavior of moral hazard in social medical insurance is easily concealed. Moreover, the third-party paying way of medical insurance, a design defect of the system itself, makes both medical staffs and patients obtain some illegal profit. Under such circumstance, the hazard control had become a touchy problem both theoretically and practically, because of the low cost of cheating in insurance, the moral features and uncertainty of medical consumption. The classification of moral hazard of medical insurance was conducted in this paper, based on illegal medical cases discovered in medical insurance of Wuhu city in recent years. Three kinds of moral hazard were introduced in this paper from the perspective of suppliers of medical insurance, demanders of medical insurance and conspiracy of suppliers and demanders. Furthermore, various representation and features of moral hazard in medical insurance were further verified through sample cases and data analysis, with reasons of their occurrence disclosed. In general, the causes of moral hazard of medical insurance were thoroughly analyzed mainly from the perspective of theoretical bases, medical insurance system, hospitals compensation, governing factors, moral factors and cost factors, by using related theory on economics, management science and other subjects, on the basis of the author's rich working experience on medical insurance. Finally, suggestions on preventing medical hazard in medical insurance were provided from many aspects:medical system, law and regulation, policy guidance, technology, supervision, and moral or ethics.