社会医疗保险中医生道德风险的决定因素及防范研究

发布时间：2019-01-30 07:39

【摘要】：为了解决人民防病治病问题我国确立了社会医疗保险制度,但是制度中存在很多问题,例如信息不对称、以药养医以及第三方支付等等,在制度保护下医生作为医疗服务提供方却为了个人利益,利用自身优势从事道德风险活动。医生的道德风险行为会产生较多的资源浪费,加剧医疗费用的不合理增长,破坏医生与患者之间关系,对医疗保险发展的可持续性是一种挑战,同时威胁着社会的安定、和谐。然而仅仅解决社会医疗保险中的信息不对称或者疾病不确定等问题,并不能很好的防范医生道德风险。因此,有必要分析社会医疗保险中医生道德风险的影响因素,并依据这些影响因素提出切实可行的防范措施,实现社会医疗保险保障人民生命健康的目的,进而实现社会医疗保险的持续发展。本文首先论述了研究背景及意义,对国内外文献进行综述,并介绍了本文的研究方法、内容以及创新点,确定了整体研究方向。其次对社会医疗保险中医生道德风险的相关概念、表现和特征进行详细的阐述,分析了社会医疗保险中道德风险的演变,并对本文所用到的委托代理理论和博弈论进行了简单介绍,明确相关概念及理论之后将进行下一步分析。接着重点以定点医院医生为研究对象,通过访谈发现影响医生道德风险的因素并不仅仅只有医生这一主体。对访谈获得的数据进行编码整理可以发现,医生道德风险涉及五大利益相关主体,这些主体都直接或间接的影响着医生道德风险行为,对影响因素进行条目数比较,可以得出其中相对重要的具体因素为下一步的分析奠定基础。之后就针对访谈结果进行分析,找出影响因素中的决定因素,并做博弈分析。对五大主体中影响医生道德风险程度的具体因素建立数据模型,得出政府、定点医院以及患者的监督是社会医疗保险中医生道德风险的决定因素,并对决定因素进行博弈论分析。最后,针对这些调研及分析结果,从五大主体视角阐释了以主体监督为主的全方位医生道德风险防范措施。本文采用文献研究、访谈与博弈论分析相结合的方法,对社会医疗保险中医生道德风险的影响因素进行了系统分析,提出了一些具体的防范措施。本文在研究视角及研究内容上有一定创新,选择与以往研究不同的视角来分析医生道德风险问题,从利益相关主体的视角来看待这一问题,剖析其中的主要影响因素;并对医生道德风险防范措施提出了一些独立见解,力求规范利益相关主体的行为,调动医生的主体性和积极性,建立一个和谐、信任的医疗环境。
[Abstract]:In order to solve the problem of people's disease prevention and treatment, China has established a social medical insurance system. However, there are many problems in the system, such as information asymmetry, medical care with drugs, third party payments, and so on. Under the protection of the system, doctors, as providers of medical services, take advantage of their own advantages to engage in moral hazard activities for their personal benefit. The moral hazard behavior of doctors will cause more waste of resources, aggravate the unreasonable increase of medical expenses, destroy the relationship between doctors and patients, and it is a challenge to the sustainability of the development of medical insurance, at the same time, it threatens the stability and harmony of the society. However, solving the problems of information asymmetry or disease uncertainty in social medical insurance is not a good way to prevent doctors' moral hazard. Therefore, it is necessary to analyze the influencing factors of doctors' moral hazard in social medical insurance, and put forward feasible preventive measures according to these influencing factors, so as to realize the purpose of social medical insurance to protect people's life and health. Then realize the sustainable development of social medical insurance. This paper first discusses the research background and significance, summarizes the literature at home and abroad, and introduces the research methods, contents and innovations of this paper, and determines the overall research direction. Secondly, the related concepts, manifestations and characteristics of doctors' moral hazard in social medical insurance are expounded in detail, and the evolution of moral hazard in social medical insurance is analyzed. The principal-agent theory and game theory used in this paper are briefly introduced, and the related concepts and theories will be further analyzed. Then it focuses on the doctors in designated hospitals, and finds out that doctors are not the only factors that affect the moral hazard of doctors through interviews. After coding the data obtained from the interview, we can find that the moral hazard of doctors involves five stakeholders, who directly or indirectly affect the behavior of moral hazard of doctors, and compare the number of items of the influencing factors. It can be concluded that one of the relatively important specific factors for the next analysis laid the foundation. Then we analyze the results of the interview, find out the determinants of the factors, and do game analysis. This paper establishes a data model of the specific factors that affect the degree of doctors' moral hazard in the five main bodies, and concludes that the government, designated hospitals and patients' supervision are the decisive factors of doctors' moral hazard in social medical insurance. And the decisive factors are analyzed by game theory. Finally, according to the results of investigation and analysis, this paper explains the preventive measures of moral hazard of omni-directional doctors from five main points of view. By using the methods of literature research, interview and game theory analysis, this paper makes a systematic analysis of the influencing factors of doctors' moral hazard in social medical insurance, and puts forward some concrete preventive measures. This article has certain innovation in the research angle and the research content, chooses the different angle of view from the previous research to analyze the doctor moral hazard question, looks at this question from the angle of the main body of interest, analyzes the main influence factor; It also puts forward some independent opinions on the prevention measures of doctors' moral hazard, tries to standardize the behavior of stakeholders, arouses the subjectivity and enthusiasm of doctors, and establishes a harmonious and trusted medical environment.
【学位授予单位】：山东财经大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1;F842.684

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