Study On Urban And Rural Medical Insurance Fraud

Urban and rural medical insurance is an important part of social medical insurance,it is in the narrow gap between urban and rural areas,solve the difficulty and high cost of the masses,a doctor,the construction of a harmonious society has played a huge role.But as a result of the current urban and rural medical insurance policy and system is not perfect,the fund audit and supervision mechanism is not sound,that diddle medical insurance fund in the prohibition of the violation behavior,seriously affect the safety and smooth running of the medical insurance fund.Therefore the research of urban and rural medical insurance insurance fraud behavior causes and prevention measures have important practical significance for our country.Based on this the paper in yongjia county of zhejiang province as an example of the typical case of urban and rural medical insurance insurance fraud,using the theory of information asymmetry in managerial economics,and game theory to analyze the causes of insurance fraud behavior.Urban and rural medical insurance insurance fraud there are three main reasons: one is the health care industry of adverse selection and moral hazard caused by asymmetric information two big problems;The second is the defects of medical insurance system itself;Three is game between the main body of medical treatment insurance caused the inevitable result of the competition.By building the medical establishment that decide a dot and ginseng protect people,medical insurance institutions and the medical establishment that decide a dot,medical insurance agencies and ginseng protect people,the game model between the we can find that insurance fraud behavior occurrence probability and penalties and illegal costs related to the occurrence of irregularities and the check the cost of health insurance institutions and is inversely proportional to the penalties.On the basis of the author put forward the corresponding countermeasure: from medical service suppliers analysis,split between medical service,standardize hospital service process,strengthening the professional training,and establish a reasonable pay system;Analysis from the perspective of medical insurance institutions,increase of medical service,change the way of existing funds settlement regulation and perfect medical insurance management system;From the perspective of the ginseng protect patients increased penalties for insurance fraud behavior,strengthen the propaganda of medical knowledge,From the perspectives of government,perfect the supervision system of medical insurance fund,strengthening the construction of medical service domain law,to strengthen the construction of information system,strengthen the management of drug market circulation,and increase the government financial investment in hospital.Hope to be able to curb the spread of the health care insurance fraud phenomenon,so as to realize the sustainable development of medical insurance fund.