医患合谋诱导医疗保险消费的道德风险及其规避

Moral Hazard of Medical Insurance Expenditure Induced by Doctor-patient Collusion and It's Avoidance

通过对医患合谋诱导医疗消费的道德风险产生的原因进行系统分析,找到规避这种风险的可行办法。医疗保险领域广泛地存在着道德风险,其中以供方诱导需求下的医患合谋表现最为突出,它的存在与目前医疗保险的付费方式、制度本身的漏洞、利益的驱使、医生的自我保护等多方面因素有关,其后果是增加了医疗保险的负担,导致了保险基金的浪费。规避供方诱导需求下的医患合谋需从政策、医方、患方三方入手,并辅以一定的配套措施,才能从源头上杜绝这种道德风险。

This article aims to find efficient measures to avoid doctor-patient collusion in medical insurance expenditure through a systematic analysis of this moral hazard .Moral hazard ,especial the doctor-patient collusion in supply-induced demand （SID） ,exist widely in the medical insurance .It is caused by many factors ：the pattern of payment in medical insurance ,the system loopholes of itself ,economic profit constraint ,the doctor’s self protection ,and so on .Due to the moral hazard ,the costs of health care are increased and lots of medical insurance funds are wasted .Therefore ,the moral hazard should be avoided through the proper actions at three aspects , the policy , the medical practitioner , and the patients .