Study On The Social Medical Insurance Fraud And The Countermeasures

Moral hazard and adverse selection are the causes of insurance fraud.In the social medical insurance,there is asymmetric information and the principal-agent relationship between the three parties of the social insurance institution,the hospital and the patient.There are moral hazard and adverse selection problems,the social insurance institutions entrusted to the medical institutions to check the patient's situation.Because of the inconsistency between the interests of the social security institutions,medical institutions and patients,the medical insurance fraud problem exists.Hospital provide medical services for the insured,so the cost of medical expenses depends on the behavior of the hospital.The medical industry has a monopoly and the hospital has information asymmetry in the process of diagnosis.In the process of providing medical services to the insured,the insurance institution is a relative disadvantage to the hospital.The relationship between profit and risk sharing is formed between the insurance institutions and hospitals,insurance institutions is difficult to get the hospital in underwriting,claims and other risk control,unable to carry out effective supervision of the hospital.This paper is based on the relevant theories of insurance,risk management,insurance and game theory,also based on the equilibrium analysis method of economics and game theory.The moral hazard and adverse selection risk in the social medical insurance market are deeply analyzed and discussed,and the actual case analysis.Focuses on the relationship between insurance fraud,the adverse selection and moral risk,it make it out that the game behavior of insurance fraud,in the end,puts forward the countermeasures and measures according to the relevant conclusions.