The Study Of Anti-Fraud In Social Medical Insurance Designated Hospitals Based On Incomplete Contracting Theory

China’s social medical insurance system has been so important that improves the life quality and health level of residents. As a main subject to provide medical treatment service, the designated hospitals are very indispensable. However, there are some fraud problems also. The’Derived demand’which comes from the third-party payment system and physician-patient conspiracy causes a huge waste of the social medical insurance fund and a damage of social credit.This article uses the design of incomplete transaction contract model and the incentive system of relational contract for reference, then analyzes the behavior characteristics of’government’and’designated hospital’based on incomplete contracting theory. It also introduces an honest showing model on short-term contract and an incentive model based on relational contracting theory on long-term contract. The dishonest and inefficiency phenomenon during the medical service providing from the designated hospitals should be reduced by running theses two anti-fraud model. The honest showing model is a sequential game, and the incentive model provides an incentive to designated hospitals by an incentive plan based on performance evaluation. There is a summary of the contract terms from a specific contract between government and a designated hospital based on the incomplete contracting theory. Then this article analyzes these two anti-fraud models above using the contract terms. To make the honest showing model efficient, regulation efficiency of government should be improved in order to reduce the degree of information asymmetry between government and designated hospitals and system on conduct restriction to government should be updated in order to make it limited strong in an incomplete contract. To make the incentive model based on relational contracting theory efficient, designated hospitals’complaint procedures should be simpler and more perfect and rationality of social medical insurance management should be improved.