The Study Of Social Medical Insurance Fraud In Designated Hospital Based On The Externality Theory

Social health insurance is the state or society to provide necessary medical services or compensation system when people are illness, injury or in the need for treatment. It is an important part of the social security system, related to the construction of the national welfare system. However, there are some problems in the operation of this system. The principal-agent model system adopted has inherent design flaws, no coordination between medicine circulation reform and the hospital management reform in market economy reform, and the professional medical knowledge lead to exist serious information asymmetry in both doctor-administrative department and doctor-patient, these reasons bring about the room of medical insurance funds fraud by designated hospital. This problem has become increasingly prominent, and damage the benefits of the insured.This paper brings in the externality theory to study designated hospital fraud and analyzes the influence of the negative externalities of fraudulent behavior, through the geometric analysis of welfare loss before and after the fraud contrast, then get the corresponding theoretical results in the condition of evading methods by using the internalization of various methods, and then obtain the appropriate internal way of externality. And it indicates that the key way to control medical insurance fraud is to raise the fraud costs and increase the probability of fraud is discovered. Meanwhile, representative meticulous analysis for cases that fraudulent of own interviews survey and related materials collections.Finally, on the basis of theoretical analysis and case analysis above, this paper proposed to increase the cost of fraud and the probability of fraud was found ways by entry point of the internal into an external. In the development of anti-fraud measures, mainly the implementation of management measures taken by government departments, supplement the reform of the market mechanism, and joint efforts of the public together to control the designated hospitals’fraud.