Legal Research Of Commercial Health Insurance Risk Prevention

Commercial medical insurance development path, not out of the background is the changes of the government organization of medical security system. Commercial medical insurance to participate in the national health insurance industry system construction has three important roles that is the main provider of added security competitors, medical insurance, basic health care institutions and health service agencies relationship explorers. Therefore, the commercial medical insurance risk prevention of further research, building perfect legal system of the commercial medical insurance risk prevention, is not only the needs of the development of commercial medical insurance itself, also has important significance for the construction of medical security system in our country.Commercial health insurance means that when the insured person suffer some disease or injuries due to a result of medical expenses that expenses paid by the insurer. Due to health cannot be measured as general merchandise, making commercial health insurance strictly distinguished from other types of insurance, risk is not easy to judge. These risks may come from the economic, the legal and policy factors. The existing frame is not complete in our country, coupled with imperfect information disclosure system, credit system and the regulatory system of insurance funds, providing the opportunity to practitioners to manipulate market.Therefore, to solve these problems, our country must improve the relevant legal system. U.S. managed care, specialized operations in Germany and the Netherlands have a legal system construction in the management of the medical model of competition also provides a successful experience for our country. In this paper, we advocate the legislation, judicial system, regulatory and policy system four aspects to prevent commercial medical insurance risk and improve the legal system.First, we should strengthen the "Business Health Insurance Law" and relevant laws and regulations system. We should establish a clear legal definition of commercial health insurance, the insurance credit laws and regulations, the insurance premium refund system. In the judicial system, we should improve the professionalism of medical insurance dispute resolution mechanisms and strengthen the normative construction forensic. In terms of the insurance regulatory system, we should strengthen corporate governance regulation, the regulatory classification of insurance funds and improve the information disclosure system. Finally, we should promote sound professional management system, medical information sharing mechanisms, tax incentives and other policies. Through the legal form to regulate content of contract, strict market access system, strengthen the building of the regulatory system, the commercial medical insurance to achieve the "legal basis", lawsuits to get fair treatment in time, can provide good market environment for medical insurance.