我国建立商业医疗保险道德风险防范机制的建议:美国商业医疗保险运行机制的启示

Suggestions on building moral hazard risk prevention mechanism of commercial healthcare insurance: Enlightenment of commercial healthcare insurance in America

国内商业医疗保险运行机制的缺失,使商业医疗保险的发展受到道德风险的潜在影响。当前商业医疗保险运行模式难以约束医疗服务行为,进而无法控制过度医疗费用的增加,发展受到一定阻碍。美国管理式医疗保健组织的运行机制能有效控制医疗费用增长,甚至在医疗保险覆盖率进一步提高的情况下,医疗费用增长率出现下降的趋势。通过总结归纳美国商业医疗保险运行机制,为国内商业医疗保险形成有效道德风险防范机制提供依据。

As the business mechanism of commercial health insurance in not perfect enough in China, moral hazard may exist and has negative impact on the development of commercial health insurance. Health service cannot be constrained effectively under that certain business model, which means the healthcare expenses will tend to be overloaded and uncontrollable, therefor, the development of commercial health insurance will be impeded. Comparatively in USA, the increase rate of healthcare expenses has slowed down under the control of Managed Care Organization, and it even became lower with higher coverage of health insurance after Obama heath care reformation. By studying and summarizing the operation mechanism of commercial health insurance in USA, this essay will dedicated to offer suggestions to perfect the business mechanism of commercial health insurance in China in order to minimize the impact of moral hazard.