Moral Hazard In Social Medical Insurance And The Strategy To Control It

Objectives: From the situation of Nanjing social medical insurance moral hazard, by introducing typical cases and data analysis, multi-analysis the personal characteristics and behaves of Nanjing social medical insurance moral hazard , and reveal the reasons of moral hazard .From monitoring mechanisms and motivational mechanism these two aspects to analyze and evaluate the existing control measures of the Nanjing social insurance moral hazard, based on medical insurance managers from the angle put forward to further improvement of the moral hazard control strategy proposal.Method:This article mainly analyses the documents and case studies and experts interviews, the type is belong to explanatory study. Documents for the analysis: refer to the documents of social insurance moral hazard home and abroad, and understand related concepts of the moral hazard and understand the study status quo of moral hazard, to offer a theoretical basis. Cases study :Medical insurance moral hazard of classification and performance, moral hazard in social health insurance is divided into two parts: the moral hazard of health service supplier (supplier moral hazard), and that of health service demander (demander moral hazard), in cases by moral hazard of fraud in each of all description. The selection interview: medical insurance experts, the relevant department head of social medical insurance management in Nanjing city, the relevant department head of designated medical institution in charge of the office in Nanjing, social medical insurance moral hazard of the specific reasons and to improve the control mechanism and the meeting is to receive expert advice and suggestions.Results and analysis: The social insurance system is flawed and our medical and health care system does not improve breeding ground for the moral hazard. From the collection of data from Nanjing to the present analysis of large amount of several contrary, the control of this phenomenon can control the most becoming. Channel payment model, Centralized management, will take charge of hospital and efficient design and restraining mechanism for regular hospital for medical insurance is the moral hazard of the problem. The new settlement method which implemented in 2006 years is a mixing advance payment in advance of the cost, this payment make as an incentive mechanism, it played an active role in restricting of moral hazard and controlling medical fees.Discussion:On medical insurance system reform and medical and health care system and the drug distribution system and reform in coordination with the premise, through scientific and system design, the overall design, can effectively avoid the moral hazard of health service supplier (supplier moral hazard), and that of health service demander; For health service supplier, the promotion of the health system reform and improve the control measures;For health service demander to further improve the social insurance system design; for medical insurance sector and increase insurance handling capacity...