我国城镇职工基本医疗保险道德风险博弈分析

Analysis on the Game Theory View of the Moral Hazard in the Urban Workers' Basic Medical Insurance

我国城镇职工基本医疗保险长期以来受到道德风险的困扰,道德风险对医疗保险事业的健康发展产生了巨大危害。本文运用博弈论方法,对医疗保险制度中医疗机构、参保人、医疗保险机构之间存在的道德风险博弈条件、博弈过程进行了分析,揭示了医疗保险道德风险存在条件、原因以及必然性。结合博弈分析,提出从破坏博弈条件、干扰破坏博弈过程两个角度防范医疗保险道德风险,具体包括加强道德体系建设、削弱医疗机构侵害医保的利益驱动、加强医疗保险信息化建设、降低博弈发生概率、建立监督激励机制等方面。

The Urban Workers＇ Basic Medical Insurance of china has been facing the moral hazard for a long time, and the moral hazard caused bad influences on the development of the Urban Workers/Basic Medical Insurance. This article uses the gaming theory to analyze the conditions and processes of the gaming between the hospital insured and the Urban Workers/Basic Medical Insurance organization and revealed the causes and existent necessity of the moral hazard, following the analysis of the moral hazard gaming, the article suggested that the moral hazard should be on guard from two large aspects, they are to destroy the conditions of the moral hazard gaming and to interfere the processes of the moral hazard gaming, specific aspects are to strengthen the moral system construction, to weaken the promotion of the economic interests, to enhance the information system, to reduce the probability of the gaming and to set up the superintend institution.