基于博弈论视角的大病保险道德风险问题研究

Study on Moral Hazard of Critical Illness Insurance Based on Game Theory

我国医疗保险中大病保险的道德风险问题由来已久,部分赔付工作由商业保险机构承办,因其处于信息劣势地位,导致商业保险机构蒙受道德风险行为带来的损失,不利于大病保险制度的长期健康发展。本文从大病保险制度中各主体的期望出发,以医疗机构和商业保险机构的双方博弈的讨论他们之间的关系、发生道德风险行为的原因以及行为策略;并进一步地提出加快改变医药结合的现行模式,改进大病保险支付方式等对大病保险的制度进行完善,从源头上解决道德风险问题。

The moral hazard problem of serious illness insurance in medical insurance in China has a long history. Part of the compensation work is undertaken by commercial insurance institutions. Because of its inferior information status, commercial insurance institutions suffer losses caused by moral hazard behavior, which is not conducive to the long-term healthy development of serious illness insurance system. Starting from the expectation of each subject in the serious illness insurance system, this paper discusses the relationship between medical institutions and commercial insurance institutions, the causes of moral hazard behavior and behavior strategies through the game between them. Further, it is proposed to speed up the change of the current mode of combining medicine with medicine, improve the payment method of serious illness insurance, etc. to improve the system of serious illness insurance and solve the moral hazard problem from the source.