大病医疗保险中医保机构的道德风险问题研究

Research on the Moral Hazard of Medical Insurance Institutions in Critical Illness Insurance

由于医疗保险市场中存在信息不对称和利益不一致,医疗供方、受益方和付费方三方均有道德风险,而道德风险的严重程度是影响医疗保险制度可持续运行的关键内生变量。大病医疗保险制度有可能诱发双重道德风险问题;一方面是医生和患者的道德风险,另一方面则是社会医疗保险机构的道德风险。本文重点探讨再保险合约中,社会医疗保险机构的道德风险问题,通过构建博弈模型来分析社会医疗保险机构与商业保险机构的行为选择,并基于模型结果探讨其政策指向性。

Because of the asymmetric information and inconsistent interests, moral hazard has widely existed in medical supplier, medical consumer and medical insurances. The degree of moral hazard is the key endogenous variable that affects the sustainable operation of the medical insurance system. Critical illness insurance system may induce double moral hazard problem： one is the moral hazard between doctors and patients, the other is the moral hazard of medical insurance institutions. This article focuses on the moral hazard of medical insurance institutions in reinsurance contract. This paper constructs the game model to analyze the behavior of social medical insurance institutions and commercial insurance agency.