医疗保险道德风险理论探讨与实证研究
发布时间：2018-07-20 15:17
【摘要】：医疗保险是为人民群众补偿医疗费用的一种保险。由于医疗卫生服务的高度专业性,导致保险者和被保险者之间的信息不对称,加上医生与患者的利益不完全一致,诱发了道德风险问题的产生。道德风险严重扰乱了保险功能的正常发挥,妨碍了医疗卫生资源的有效配置。在医疗保险中存在事前道德风险和事后道德风险两大类,其中事后道德风险对医疗保险基金的冲击最大。 医疗保险涉及到政府、医疗保险机构、医疗服务机构和被保险者四个方面,但是政府作为管理部门不直接参与医疗保险的具体运作,只是起监督和政策扶持作用。因此,医疗保险中的道德风险主要来源于医保机构、医疗服务机构和被保险者三方。在解决医疗保险道德风险的过程中,医疗服务机构是解决医疗保险道德风险的关键,也是影响被保险者道德风险的重要因素之一。 本文通过个案研究,以天津市某三甲医院产科支付方式改革前后医疗费用变化为切入点,研究支付方式对医患双方道德风险的影响。一方面从理论上阐述了医疗保险道德风险的来源及影响因素,另一方面,结合天津市某三甲医院医疗支付方式改革的实践经验,进一步思考如何推进医疗保险支付方式向科学、合理的方向发展。研究医疗服务机构的道德风险及其预防措施,对于保障医疗保险基金的稳定性,医疗卫生服务的公平性和可及性具有十分重要的意义。
[Abstract]:Medical insurance is a kind of insurance which compensates for the people's medical expenses. Due to the highly professional nature of the medical and health services, the information asymmetry between the insured and the insured, coupled with the incongruity of the interests of doctors and patients, leads to the emergence of moral hazard. Moral hazard seriously disturbs the normal function of insurance and hinders the effective allocation of medical and health resources. There are two types of moral hazard in medical insurance: moral hazard in advance and moral hazard after the event, in which moral hazard after the event has the greatest impact on the medical insurance fund. Medical insurance involves four aspects: government, medical insurance organization, medical service organization and insured person, but the government, as the management department, does not participate in the concrete operation of medical insurance directly, but only plays the role of supervision and policy support. Therefore, the moral hazard in medical insurance mainly comes from health care institutions, medical service organizations and insured persons. In the process of solving the moral hazard of medical insurance, medical service organization is the key to solve the moral hazard of medical insurance, and it is also one of the important factors that affect the moral hazard of insured person. Based on the case study, this paper studies the effect of payment mode on the moral hazard of doctors and patients by taking the change of medical expenses before and after the reform of obstetrical payment mode in a third Class A Hospital in Tianjin. On the one hand, the origin and influencing factors of medical insurance moral hazard are expounded theoretically. On the other hand, combining with the practical experience of medical payment mode reform in a third class hospital in Tianjin, the author further thinks about how to promote medical insurance payment mode to science. A reasonable direction of development. It is of great significance to study the moral hazard of medical service institutions and its preventive measures to ensure the stability of medical insurance fund and the fairness and accessibility of medical and health services.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684
本文编号：2133949
[Abstract]:Medical insurance is a kind of insurance which compensates for the people's medical expenses. Due to the highly professional nature of the medical and health services, the information asymmetry between the insured and the insured, coupled with the incongruity of the interests of doctors and patients, leads to the emergence of moral hazard. Moral hazard seriously disturbs the normal function of insurance and hinders the effective allocation of medical and health resources. There are two types of moral hazard in medical insurance: moral hazard in advance and moral hazard after the event, in which moral hazard after the event has the greatest impact on the medical insurance fund. Medical insurance involves four aspects: government, medical insurance organization, medical service organization and insured person, but the government, as the management department, does not participate in the concrete operation of medical insurance directly, but only plays the role of supervision and policy support. Therefore, the moral hazard in medical insurance mainly comes from health care institutions, medical service organizations and insured persons. In the process of solving the moral hazard of medical insurance, medical service organization is the key to solve the moral hazard of medical insurance, and it is also one of the important factors that affect the moral hazard of insured person. Based on the case study, this paper studies the effect of payment mode on the moral hazard of doctors and patients by taking the change of medical expenses before and after the reform of obstetrical payment mode in a third Class A Hospital in Tianjin. On the one hand, the origin and influencing factors of medical insurance moral hazard are expounded theoretically. On the other hand, combining with the practical experience of medical payment mode reform in a third class hospital in Tianjin, the author further thinks about how to promote medical insurance payment mode to science. A reasonable direction of development. It is of great significance to study the moral hazard of medical service institutions and its preventive measures to ensure the stability of medical insurance fund and the fairness and accessibility of medical and health services.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684
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