我国商业健康保险风险控制研究

发布时间：2018-09-17 16:39

【摘要】：商业健康保险的风险防范问题不单单关乎保险公司兴衰成败，而且对社会主义和谐社会的建立，国家经济社会的稳定健康发展都有着非常重要的作用。本文通过对我国现阶段商业健康保险现状及问题的深入分析，结合中国健康保险经营的实际情况，借鉴国外商业健康保险风险管理的实际经验和研究成果，结合我国现阶段基本国情，对我国商业健康保险风险防控做出了整体设计和初步研究，试图为商业健康保险的经营活动提供参考。本文运用经济学和管理学的一些研究成果，分析和论证了逆向选择和道德风险经济学含义、产生的原因、表现形式以及造成的后果等，指出信息不对称问题而产生的逆向选择和道德风险现象是阻碍商业健康保险健康发展的根本原因，逆向选择和道德风险是保险机制发挥作用的最大障碍，并提出了解决此问题的一些方法。最后联系美国和巴西的保险管理模式，针对我国的现实国情，提出了防范和控制逆向选择和道德风险的具体措施和可行性方案。本文第一章阐述了研究的背景、意义、问题的提出，并对国内外研究现状进行了回顾和综述；第二章分析了商业健康保险的基本概念、市场中各行为主体的特点及信息不对称问题、分析了商业健康保险的可保性条件及相关理论进行了论述；第三章主要对商业健康保险的风险现状及其产生的原因进行了分析；第四章研究了美国和巴西等国家的健康医疗保险模式，对我国来说可以借鉴相关经验；第五章以逆向选择和道德风险为切入点，，通过对我国商业健康保险现状及所处社会经济环境的分析，使用信息不对称理论提出从完善个人健康档案、健全完善监督监管力度、建设专业化的人才队伍、健全覆盖双方的信用机制等方面着手来降低商业健康保险风险成因，希望能对我国商业健康保险制度机制建设的快速健康发展提供参考和启示；第六章是对全文得出结论和探讨下一步需要研究的问题。
[Abstract]:The risk prevention of commercial health insurance is not only related to the success or failure of insurance companies, but also plays an important role in the establishment of socialist harmonious society and the stable and healthy development of national economy and society. By analyzing the current situation and problems of commercial health insurance in China, combining with the actual situation of health insurance management in China, this paper draws lessons from the practical experience and research results of commercial health insurance risk management in foreign countries. Combined with the basic situation of our country at present, this paper makes an overall design and preliminary study on the risk prevention and control of commercial health insurance in China, and attempts to provide a reference for the business activities of commercial health insurance. Using some research results of economics and management, this paper analyzes and proves the meaning, causes, forms and consequences of adverse selection and moral hazard economics. It is pointed out that adverse selection and moral hazard caused by asymmetric information are the fundamental reasons that hinder the healthy development of commercial health insurance, and reverse selection and moral hazard are the biggest obstacles to the function of insurance mechanism. Some methods to solve this problem are put forward. Finally, according to the actual situation of our country, the concrete measures and feasible schemes of preventing and controlling adverse selection and moral hazard are put forward according to the insurance management mode of the United States and Brazil. The first chapter describes the background, significance and problems of the research, and reviews the current research situation at home and abroad, the second chapter analyzes the basic concepts of commercial health insurance. The characteristics of various actors in the market and the problem of information asymmetry are analyzed, and the insurability conditions of commercial health insurance and related theories are discussed. Chapter three mainly analyzes the risk situation of commercial health insurance and its causes. The fourth chapter studies the health care insurance models of the United States and Brazil, which can be used for reference by our country. Chapter five focuses on adverse selection and moral hazard. Based on the analysis of the present situation of commercial health insurance in China and the social and economic environment in which it is located, and using the theory of asymmetric information, this paper puts forward the following points: perfecting personal health records, perfecting supervision and supervision, and building up specialized talents. Improve the credit mechanism of both sides to reduce the causes of commercial health insurance risk, hoping to provide reference and inspiration for the rapid and healthy development of commercial health insurance system construction in China; The sixth chapter is to draw the conclusion of the full text and to explore the next need to study the problems.
【学位授予单位】：河南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

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