社会基本医疗保险中的道德风险及应对思路分析

Analysis of Moral Hazard in Social Basic Medical Insurance and Its Countermeasures

为了实现人民对美好生活的向往,国家越来越注重保障国民基本权益和提升居民的社会福利水平。社会基本医疗保险制度发展至今虽已取得一定成效,但由于发展时间短、立法不够完善、医疗费用支出快速增长、参与主体多元化等因素致使社会基本医疗保险在实际运营过程中存在一些弊端,其中道德风险的问题尤为突出,这在一定程度上影响了社会医疗保险事业的健康发展。探讨社会基本医疗保险中的道德风险问题,分析医疗服务提供方、医疗服务需求方和医疗保险机构三大主体间道德风险可能出现的原因并思考应对策略,可通过建立较完善的信息甄别机制、立法约束违规成本、提升医护人员的职业道德素质与构建医保基金监督体系等方面进行完善,从而推动我国卫生健康事业可持续发展。

In order to realize the people’s yearning for a better life,the state has paid more and more attention to protect the basic rights and interests of its citizens.Although the development of social medical insurance system has begun to have some results,but due to the short development time,insufficient legislation,rapid growth of medical expenses and diversification of participants and other reasons,social medical insurance in the operation of social health insurance still has certain problems,of which the moral hazard problem is particularly prominent,seriously affecting the development of China’s social medical insurance.In view of the moral hazard problem in social medical insurance,analyzing the causes of the moral hazard of various subjects and exploring countermeasures,to analyze the possible causes of moral hazard among medical service providers,medical service demanders and medical insurance institutions,and to think about the coping strategies,we can improve the medical insurance system by establishing a more perfect information screening mechanism,restricting the cost of violations by legislation,improving the professional ethics of medical staff and constructing the supervision system of medical insurance fund,etc.So as to promote the sustainable development of health care in China.