The Research Of Controling The Moral Risk Of Commercial Health Insurance In China

With the rapid development of China’s market economy and the comprehensive national strength, medical and health levels is also gradual increasing. With the medical technology progress increasing, medical costs is growing at an alarming rate. The Characteristics of primary stage of socialism in our country determine the level of social health insurance that is still having some flaws. The importance of the commercial health insurance is becoming increasingly prominent. At present, the development of commercial health insurance market in China still exist many problems. The operating profit of health insurance companies is low and the loss ratio is high. There are some serious defects in the health insurance mode of "third party payment", thus increasing the moral hazard of doctor-patient collusion. The compensation mechanism of medical service price but depends on the price also brought about the naissance of the health insurance moral hazard. The main body of market behavior has been lack of trust and the behavior main body relations of normal market have been twisted in today. To set up a good operation system of health insurance can keep the balance of the interests of the subject of the commercial health insurance market behavior, meet the medical needs of the masses, support the medical system reform, and facilitate economic development. The importance of commercial health insurance is increasingly prominent.We construct the game model among the insurance company, insurant and medical institutions based on the game theory models. Model results show that the cost of moral hazard is directly affected by the insurance company regulation level and supervision. If increasing the risk of cost for default of medical institutions, the insured and the insurance agent will reduce the risk of moral hazard behavior and safeguard the legitimate rights of both sides. Insurance companies adopt multi-channel and several strategies to improve their risk control ability, strengthen the supervision of medical service demand, encourage the mechanism of benefit sharing and improve the operating condition of the health insurance company to curb the moral hazard behaviors. This paper also draw lessons from the successful experience of commercial health insurance in the United States, to explore the commercial health insurance new technologies, and to study the effective measures of managed care in curbing the risk of moral hazard behavior. Combining the concrete national conditions of China, we study the Chinese commercial health insurance moral hazard controlling problem from medical institutions, insurant, insurance company and medical service supervision party. Insurance companies, medical institutions and social supervision must work together to play an important role in health insurance.