Prevention And Control Of Health Care Providers’Moral Hazard In Social Health Insurance

With the rapid expansion of medical expenses all over the world over the past20years, the question of how to control the unreasonable rise of medical expenses has become a common issue for many countries. Medical service providers tend to provide excessive medical services out of their personal interests, which leads to medical moral hazard, medical resource allocation inefficiencies and an irrational increase of medical expenses. Due to the large population and a medical insurance system that is not well developed, the ethical problem of medical service providers is particularly prominent in China nowadays. The problem that health insurance is expensive and difficult to obtain has affected people’s normal lives and has become a threat to social stability. Therefore, it is particularly urgent to promote the investigation of the moral hazard of medical service providers in social health insurance, as well as establish and improve mechanisms to govern moral hazard.This paper is divided into the following sections:first, the preamble discusses the research background and significance of this study, then it introduces relevant research conducted in China and abroad, and concludes with a brief introduction to the main content and methodology, along with the innovations and inadequacies of this paper.Second, there is a review of the development process of the medical insurance system since the founding of New China, the medical problems of moral hazard, followed by a cost-effectiveness analysis of the present health insurance services using the DEA mathematical model, based on which assesses the influence scale of moral hazard in China.Third, there is an overview of the market relationships of various medical subjects, analyzed using econometric models and the Bayesian theory model. It analyzes the medical service providers’behavior in the medical market and finds that the medical service providers’moral hazard is mainly caused due to the absence of a doctor review system in the health care market, as well as an unreasonable financial compensation policy in public hospitals that has existed since health care was first reformed.Fourth, the paper describes the development process of foreign medical moral hazard, which discusses three paths used to inhibit moral hazard abroad. By using comparative studies of the techniques to govern medical moral hazard in China and foreign countries, the paper summarizes useful insights on future moral hazard prevention in China. Some of the prevention techniques include creating a body to manage insurance plans as well as the health insurance market, changing the focus of medical resources and services from quantity control to structure control, and shifting control from a single regulatory body to a cooperative multi-subject body for medical services.Fifth, based on lessons learned before, the paper concludes with three paths for how to move forward:internal self-regulation, identifying external constraints, and improving resource allocation to establish an effective mechanism for the prevention and control of medical moral hazard. The paper concludes by summarizing the whole research content.