Research On Moral Hazard Of Urban Staff Basic Medical Insurance System In Shanxi Province

The 13 th Five Year Plan has put forward to continuously deepen reform of important fields. Medical is the vital field associated with livelihood issue, however, it suffers from severe obstruction of moral hazard in the reform process. Moral hazard impairs individuals, enterprises and countries in many aspects and has extremely harsh social impacts. Against this background, to research on moral hazard is of great importance, especially in following aspects: first, medical insurance would own its basic function; second, medical insurance fund would secure its operation, avoid being illegal extracted or defrauded and discard unreasonable medical expense increased;third, medical service resource would be made full use to improve the difficulties of getting medical service, accelerating the complementation of a well-off society in an all-round way.Based on risk information asymmetry theory, risk management theory,principal-agent theory and other correlation theories, this paper takes researches on the implementation and operation of staff medical insurance in Shanxi province by empirical analysis and data reduction. Through typical case analysis, this paper concludes that the representation of moral hazard in Shanxi province, including moral hazard from demand side of medical service, like excessive medical and illegal counterfeit, as well as moral hazard from provider side of medical service, like induced demand, irregular charge and pharmacy violations. Moreover, this paper also analyses the theories of the causes of moral hazard by practical analysis and the severe impair of moral hazard on many fields in Shanxi province by data collection.In the process of implementing medical insurance reform in Shanxi province,many measures are taken to prevent moral hazard of staff medical field. Through the analysis of effects of these measures, this paper concludes the existing issues of moral hazard prevention, such as disharmony between reform and current system, imperfect compensation policy, uneven progress in counties and fragile achievements, overload financial burden and enlarge coverage of staff medical insurance.In conclusion, combined with the beneficial reference and flaws of moral hazard prevention of foreign developed countries as well as current situation of Shanxi province, this paper put forward advises of avoiding moral hazard in staff medical field:as for demand side of medical service, the responsibilities of enterprises and individuals should be clarified, avoiding unbalance responsibility, reasonable controlling andadjusting medical service level, building sound classification of diagnosis and treat system and enlarging staff medical insurance coverage by economic development; as for provider side of medical service, medical insurance, third-party negotiate payment in advance and payment reform should be guided by sharing idea, perfecting the compensation mechanism for the medical cost through drug-selling profits and strengthening supervision.