基于第四方医院复核机制的社会医疗保险供方道德风险防控研究

Moral Hazard of Medical Care Providers and Its Preventions in Social Medical Insurance-Based on the forth-party recheck system

医疗保险领域中的道德风险具有发生可能性大,造成的后果严重,而防范的措施又难以制定的特点。由于医疗领域的信息不对称性,医疗服务的提供方往往决定了医疗服务的种类和价格,故而社会医疗保险中的供方道德风险尤其显著。其又具有发生可能性大,造成后果严重,且防范措施又难以制订的特点。因此,如何衡量和防范社会医疗保险中的供方道德风险成为一个具有重要理论和实践意义的课题。文章在前人的研究基础之上,运用信息经济学、博弈论等学科的相关知识,对我国现有社会医疗保险体系中的供方道德风险进行了深度分析。从理论上证明了我国社会医疗保险领域的供方道德风险的存在,进而提出利用第四方复核机制防控供方道德风险的方案,并通过博弈论方法证明了其可行性。

With the serious consequences and the difficult to prevent,social health insurance may have a high possibility to generate the moral hazard. As a result of information asymmetry,the providers of medical care always determine the type and price of medical service. In other words,the moral hazard of medical care providers is the most significant moral hazard in social health insurance. Therefore,it has been an important projects that how to measure and to prevent moral hazard of social health insurance. On the basis of summarize the previous related research,with the usage of information economics and game theory,this paper does a deep study on moral hazard of medical care providers in the current social medical insurance system. We theoretically prove the existence of moral hazard of medical care providers in current social medical insurance system,and propose a brand new improvement program which utilizes the forth- party recheck system to control the moral hazard of medical care providers. Moreover,this paper uses game theory to prove that the new program is feasible.