医疗保险中道德风险的规避对策研究.pdfVIP

要 医疗保险领域广泛存在着道德风险，本文分三部分介绍了我国社会医疗保险 中的道德风险问 。第一部分分析了社会医疗保险的性质、特征、功能以及我国 社会医疗保险大体情况，进而根据道德风险的含义引申出社会医疗保险中道德风 险的含义。第二部分分析了社会医疗保险中道德风险的表现及产生的 因（在第 三方付费的基础上，由于信息不对称、个人机会主义、医疗消费的特殊性以及我 国目前社会医疗保险制度的漏洞等原因，造成了我国社会医疗保险制度中道德风 险的蔓延），并分析了道德风险的消极影响。第三部分，首先，梳理了我国社会医 疗保险制度的改革过程，并对我国社会医疗保险制度改革进行了评价和反思；其 次，分析并总结了国外规避道德风险的经验；最后，提出了我国社会医疗保险中 道德风险的规避措施，其总体思路是：在吸取国内外规避道德风险的经验教训的 基础上，在保证我国社会医疗保险的保障功能的前提下，根据我国的实际情况， 采取一系列制度性的举措，从医患双方入手，并辅以一定的配套措施，以遏制道 德风险的蔓延。 关键词：社会医疗保险 道德风险 风险规避 制度 1 Abstract Moral hazard existed in the Medical insurance widely. In this paper, three parts focused on the problem of moral hazard in our countrys social medical insurance. The first part analyzed the social medical insurance characteristics, functions and social medical insurance generally, and in the meaning of moral hazard. The second part analyzed the situation and the reasons for the risks (based on the third party payment 、 information asymmetry、 personal opportunism, particularity of the medical consumer and the social medical insurance system loopholes, moral hazard is spread in our social medical insurance system widely)and its negative influence. The third part, first of all, carded Chinas social medical insurance system reforming process and made evaluation and reflection our social medical insurance system; and then, analyzed and summed up the abroad experience to avoid moral hazard; Finally, put forward some measures to avoid the moral hazard in Chinas social medical insurance. To its overall, the idea is: based on the native and abroad experience, to avoid the risk of moral, under the premise of support functions, according to Chinas actual situation, took a series of institutional initiatives to curb the spread of moral hazard from the patients and the doctors,