基于成本—收益理论的社会医疗保险欺诈问题研究

The Study of Social Medical Insurance Fraud Based on Cost-Benefit Theory

通过引入成本—收益理论,对社会医疗保险制度中的欺诈问题进行研究,比较该制度中各参与主体的成本、收益构成,分析各影响因子对欺诈与反欺诈行为的影响,研究表明:欺诈与反欺诈行为受行为成本、行为收益大小的制约,且有其相应的约束条件。在此基础上,提出了相应的反欺诈对策。

Introducing the cost-benefit theory to analyze the social medical insurance fraud, this paper compares the components of each participant＇s cost and benefit in medical insurance sys- tem, and analyzes the effect of influencing factor on fraudulent behavior and anti-fraud behavior. It is founded that fraudulent behavior and anti-fraud behavior were restricted by behavior＇s cost and benefit, and moreover, these behaviors have corresponding constraint conditions. Based on the above, this paper presents the corresponding countermeasures.