Research On Moral Hazard Control Strategy Under The Background Of Unreasonable Medical Expenditure

Objective Medical expenses increase rapidly’s reasons include aging society,technology,medical demand,and moral hazard from patients and hospitals.This aim to analyzes moral hazard’s mechanism and manifestation based on unreaso nablemedical expenses,use insurance fund to show moral hazard,and list international moral hazard control measures,the effectiveness of the "medical" and "insurance" cooperation to control moral hazard,then propose measures.Methods The literature explain the mechanism of moral hazard;VAR model analyzes moral hazard’s performance of commercial health insurance;Heckma n model analyzes moral hazard’s performance of autoinsurance;the literature describes the insurance’s fund losses caused by moral hazard and internationa l’s control measures;questionnaire survey and PSM-DID analyze insurance companies’ perceptions of moral hazard and cooperation effect between them.Results(1)The patients and hospitals have moral risks in order to maximize their own utility and maximize profits,such as increasing medical services andetc,excessive consumption.under the third-party payment,the higher reimbur sement ratio,the higher unreasonable medical expenses,the higher affordability of the hospitals,the more medical services provided;(2)Through the theoretical analysis of VAR model and Heckman model,moral hazard includes decomposition of hospitalization,general examination,prolonged hospitalization,and increased number of operations;(3)From the insurance fund we can seedec omposing hospitalization,over-examination,pretending else’s card;(4)International moral hazard control measures,including the US’ ACO,bundled payment model,etc.the UK drugprice supervision plan,etc.Japan based on the combination of diagnostic procedures(DPC)payment system;German physician target quota system,etc;(5)Cooperation between insurance companies and hospitals can shorten the length of hospital’s stay and reduced medical expenses,but the cooperative hospitals still exist moral hazard.Suggestion In order to distinguish the objects of moral hazard control more clearly,proposes moral hazard control measures from patients,hospitals and insurances.First,reduce patients’ moral hazard: strengthen patients’ behavior,guide them to seek medical treatment in an orderly manner and reduce moral hazard;improve the ability of primary medical services,thus provide rational medical decisions for patients,and increase market competitiveness;adjust moderate reimbursement ratio to control patients overtreatment,and redce unnecessary medical expenses;Second,reduce hospitals’ moral hazard: promote medical and health’s reform,increase financial subsidies,to change hospital’s treatment model;standardize the diagnosis and treatment of hospital,show the public Medical expense’s information to alleviate information asymmetry in medical;improve medical’s mechanism,establish adjustment mechanism of medical service price based on cost and income,reduce hospital over-examination problem;using admission supervision system,DRGs two-week re-admission,comprehensive supervision results coordinated by mechanism and blacklist system,to restrict the decomposition of hospitalization behavior;Third,insurance companys’ measures: establish and improve the medical security benefits checklist system,clarify the the welfare’s boundary;encourage insurance companies and hospital to explore more Multi-cooperation model,and perfect the laws and regulations to push them cooperation;optimize the compensation mechanism of hostpital,and promote the main from insurance to hospital;establish effective payment methods and strengthen the incentive mechanism;accelerate the direct connection between medical insurance agencies and drug dealers to separation them;join more third-party,implement dynamic intelligent monitoring of data,to reduce unreasonable growth of medical expenses.