Research On China's Health Insurance Fraud And Medical Underwriting System

With the establishment of China's accession to the World Trade Organization and the multi-level universal medical security system,commercial health insurance has achieved good development in recent years.However,with the rapid development of health insurance,the phenomenon of insurance fraud in the insurance market has become increasingly serious.In order to effectively avoid the problem of health insurance fraud caused by moral hazard and adverse selection,reduce the incidence of insurance fraud cases,and promote the healthy and orderly development of the insurance market,it is imperative to improve China's medical underwriting system.Medical underwriting is the choice of the subject matter of insurance and the rate at which it is underwritten.It is the process of matching the underwriting condi tions with the risk situation.The quality of medical underwriting work determines the size of the insurance company's operating risks and the quality of its operating benefits,which is a very important part of the insurance company.Through a case study of AIDS and hepatitis B underwriting,this paper expounds the effect of the improvement of China's medical underwriting system on the reducti on of insurance fraud and analyses the problems existing in China's current medical underwriting system,using theoretical analysis,game analysis and case analysis,and then puts forward some countermeasures and suggestions to improve the system.The problem of preservation is put forward,and the countermeasures and suggestions for perfecting China's medical underwriting system are put forward.Firstly,this paper introduces the concepts of insurance fraud and medical insurance from the theoretical point of view,which explains that the occurrence of insurance fraud is mainly caused by adverse selection and moral hazard caused by information asymmetry in the insurance market,and introduces the underwriting technology of standard body,sub-standard body,non-insurance body and the various system diseases in medical underwriting;Secondly,this paper explains the reasons why the problem of insurance fraud is becoming more and more rampant in the insurance market at present: first,the cost of investigation is too high for insurance companies;second,the legal system of anti-fraud is inadequate and the crackdown on fraud is not strong enough;Then,this paper illustrates the existing problems of medical nuclear preservation in our country,including obesity,alcoholism,inaccurate or lack of commentary on some diseases;Finally,this paper puts forward some countermeasures and suggestions to improve China's medical underwriting system from the aspects of technology,legal system,personnel and process.