The Research On The Risk And The Risk Control Of China’s Commercial Medical Insurance

In recent years, with the central government gradually pays more and more attentionon social security, solving the health problem has been emphasized by all levels ofgovernments. They emphasized the importance of this issue in all relevant decisions andincreased the inputs of local health. In April,2009,“Chinese Communist Party CentralCommittee’s Proposal on Deepening Medical and Health System” was announced. Thisprogram encouraged businesses and individuals to participate in the commercial medicalinsurance actively in order to meet the exceed needs of health insurance besides the basicmedical insurance. For governments attach importance to the resident’s medical healthproblems, they provide policy support for the development of commercial medicalinsurance, and the new medicine reform provides a good development space for thecommercial medical insurance from the aspect of positioning the system, determining thedevelopment direction and the implementations and so on.Commercial medical insurance as a part of the medical security system, it is animportant complement to the social security. It can meet the growing demand for medicalservices and its importance can not be ignored. In recent years, China’s commercialmedical insurance market maintained a rapid development level with the increasing of thenumber of health insurance business entities, a wide range of products and coverageexpanded, but compared with the urgent needs of the people, its development is stillrelatively slow and its process also revealed some problems. Currently, the lack of riskcontrol methods of commercial medical insurance has become a bottleneck restricting thedevelopment of medical. Whether the commercial medical insurance can be successful isdetermined by whether its risk can be controlled properly. Medical insurance of ourcountry is still at an early stage of development, and the research about the risk and the riskcontrol of the commercial medical insurance is just beginning. Therefore, we have toanalysis the exist risk and take appropriate measures to control the risk in order to promote the rapid development of China’s commercial medical insurance.This article takes the risks and risk control of commercial medical insurance as thecore content, with using Insurance Theory, Asymmetric Information Theory, and GameTheory, combining with China’s commercial medical insurance development status andexisting problems, then analysis the causes, manifestations and hazards of the risk ofpayment, the risk of product designing, the risk of adverse selection and the moral hazardon the exiting health insurance market. In addition, using the Game Theory Model to focuson the research of moral hazard. The analysis finds that the domestic commercial medicalinsurance risk control mechanism exists problems. Under the referencing of foreignexperience and the previous studies, this paper proposes a series of suggestions to achievethe risk control in line with the development of China’s commercial medical insurance,including the implementation of managed medical mode, promoting the effectiveconvergence between the social health insurance with commercial medical insurance,improving payout method of settlement, promoting the design of innovative products andso on.