诚信体系：防控社会医疗保险道德风险的理性选择

发布时间：2017-12-27 07:32

  本文关键词：诚信体系：防控社会医疗保险道德风险的理性选择　出处：《吉林大学》2017年博士论文　论文类型：学位论文

  更多相关文章： 社会医疗保险 信息不对称 道德风险 诚信体系

【摘要】：当下,在我国医疗服务市场中广泛存在过度医疗、医保套现等失信现象,社会医疗保险的制度安全受到严重威胁。这些失信现象的发生具有普遍性和多样性,其背后的影响因素极为复杂。对效用的过度追求是人们失信的根本动机,失信乱象实为各类因素引发医保领域中道德风险的具体表现。面对由道德风险引发失信乱象所致的医保领域诚信缺失现状,在顶层设计中不断完善和优化制度的基础上,运用诚信社会资本构建社会医疗保险道德风险长效防控机制,是治理医保领域失信乱象频发、提高医疗服务市场诚信水平、维护医疗服务市场运营秩序、保护社会医疗保险制度安全运行的理性选择。美国著名经济学家肯尼斯·阿罗(Kenneth J.Arrow)于上世纪60年代首次提出道德风险这一微观经济学经典概念,此后经诸多学者对其不断进行深入研究,得出结论,认为道德风险是因信息不对称(亦称为非对称信息)而产生的系统性风险,属于一种不可保风险,且具有不可消除性。作为一种与道德有一定关系的风险,道德风险并不等同于道德败坏。从风险发展变化的过程看,道德风险的产生和存在与人们的伦理道德无关,道德风险的发生则在一定程度上受到道德的影响。道德风险与逆向选择被认为是由于经济市场交易活动中存在的非对称信息现象导致的,其对交易合同契约造成的负面影响一般因失信行为种类繁多而程度不一,但道德风险与逆向选择对保险行业——尤其是前者对于社会保险制度体系的安全运行造成很大威胁。当前在社会医疗保险领域中存在的大量失信现象,实际上是各类相关因素诱发道德风险而产生的。因此,医保领域中的失信现象是医保道德风险发生的具体表现。非对称信息是道德风险产生的根源,对医保道德风险的研究则应当从非对称信息入手。通过理论分析,本文认为,非对称信息恒常存在于人类生活几乎所有领域之中,其对所在领域产生的影响应从积极和消极两个方面理解。在经济领域中,非对称信息会因市场环境的优劣而产生不同的影响:在有序竞争环境中,道德风险发生的概率被有效抑制,非对称信息能够形成正和博弈、促进有效竞争,产生积极影响;在无序竞争环境中,非对称信息所引起的逆向选择、道德风险等问题将造成实质性危害,使契约中的一方或多方的正当收益蒙受不合理的损失,产生消极影响。对非对称信息的片面理解将导致人们为消除道德风险而过度追求最优制度设计,反而容易忽视构建道德风险防控机制的必要性。正确理解和认识非对称信息与道德风险,是医保道德风险防控机制研究工作的重要基础。由于我国社会医疗保险制度采用国家、用人单位和个人三方共同支付医疗费用的制度设计,使得医疗卫生服务市场的参与主体数量远多于其他社会保险项目,因而医保领域道德风险的风险水平极高,由各类因素引发道德风险所产生的医保卡套现、过度检查、开大处方、医患纠纷等医疗服务市场乱象频发。这些不诚信现象之所以能够发生,一方面是由于制度设计、市场交易规则设计存在需要继续完善的空间和亟需补全的结构性漏洞,另一方面则是由于当前社会医疗保险制度体系中缺乏有效的道德风险防控机制。这些因素的存在,使得医保市场参与主体易于在逐利欲望的驱使下施行不诚信行为,从而引发道德风险。由此可见,现有的制度设计和市场结构,显然无法有效防控医保道德风险。目前我国医保市场失信行为屡禁不止,实然状态与应然状态之间差距巨大。在深挖其成因的基础上,提出缩小差距解决问题的思路和对策,是本项研究的重点。始于上个世纪70年代的社会资本理论研究指出,诚信不仅是一种内生的道德理念,更是一种可以外化的社会资本。在医保领域失信乱象频发的背景下,探讨如何将诚信社会资本运用于建设医保道德风险长效防控机制,具有特别现实的积极意义。本项研究将重点围绕以下几个方面展开:第一,社会医疗保险领域存在失信乱象的基本成因。医保失信问题的广泛出现危害极大,通过梳理失信表现分析其成因,是从根本上探寻解决问题路径的基础。第二,医保道德风险产生和发展过程的影响因素。道德风险属于风险的一种,风险存在与风险发生是截然不同的风险状态,其实际影响有着天壤之别,明晰道德风险发生过程的内在机理,对道德风险防控研究意义重大。第三,非对称信息现象恒常存在的本质及其现实意义。对道德风险问题追根溯源,是摸清问题本质的需要,对非对称信息、道德风险等概念的正确理解是寻找医保道德风险防控路径的根本出发点。第四,诚信作为一种传统意义上的道德概念,能否外化为社会资本并用于社会治理问题。诚信是中华传统文化的瑰宝,是信任实现的基础。运用诚信社会资本构建医保道德风险防控机制,在理论层面、实践层面是否具有科学性和有效性,值得深入研究。第五,构建社会医疗保险诚信体系对于防控医保道德风险的必要性。不断完善和优化现有制度是规避道德风险的重要手段,但仅仅依赖制度层面的努力是远远不够的,实践层面道德风险防控机制的缺失是不争的事实。第六,医保诚信体系的框架结构和内容。经验证明,任何一项制度体系的建构,都是在特定理论的指导下展开的,其结构和内容应具有系统性、科学性。第七,社会医疗保险诚信体系防控医保道德风险的有效性问题。医保诚信体系的结构设计应当做到既符合理论研究要求,又能够满足实践工作的需要。社会保障作为一门综合性应用学科,其研究工作不仅应在理论层面有所突破,更要求研究成果能够对社会保障制度实践提供帮助。本文以中外非对称信息、道德风险、诚信等理论研究为基础,结合医保诚信缺失等实然现状,对医保道德风险问题进行了深入的理论研究,通过分析信息不对称、人的社会化、道德风险之间的作用机理,指出了在医保道德风险治理中引入诚信社会资本进行防控机制建设的必要性,最后对社会医疗保险诚信体系的框架结构进行了科学设计,并分析了其满足理论研究要求和实践工作需要的有效性。
[Abstract]:At present, in China's medical service market, there is a wide range of discredit phenomena such as excessive medical treatment and medical insurance, and the system security of social medical insurance is seriously threatened. The occurrence of these discredited phenomena is universality and diversity, and the factors behind them are very complex. The excessive pursuit of utility is the fundamental motive for people to lose faith. Dishonesty is a concrete manifestation of moral hazard in the field of medical insurance. In the face of the lack of medical insurance credit status caused by the chaos caused by breaking the moral risk, constantly improve and optimize the system based on the top-level design on the construction of long-term mechanism of the prevention and control of moral hazard of social medical insurance by the integrity of social capital, governance, is a frequent medical field to improve the medical service market chaos dishonesty integrity level, maintaining order, the medical service market operation the protection of the safe operation of the rational choice of social medical insurance system. The famous American economist Kenneth Haro (Kenneth J.Arrow) in the last century was first proposed in 60s the moral hazard of microeconomics classic concept, then by many scholars to continue in-depth study, concluded that the moral risk is due to asymmetric information (also known as asymmetric information) systemic risk arising, belongs to an uninsurable risk and, can not eliminate. As a risk that has a certain relationship with morality, moral hazard is not the same as moral failure. From the perspective of the development and change of risk, the emergence and existence of moral hazard is not related to people's ethics and morality. The occurrence of moral hazard is affected by morality to some extent. Moral hazard and adverse selection is considered to be due to the asymmetric information phenomenon of economic activity in the market, the negative impact on the contract transaction contract generally because of dishonest behavior and various kinds of varying degrees, but the moral hazard and adverse selection in the insurance industry, especially the former caused great threat to the safe operation of the social system insurance system. At present, a large number of dishonesty in the field of social medical insurance is actually caused by various related factors inducing moral hazard. Therefore, the phenomenon of dishonesty in the field of medical insurance is the concrete manifestation of the moral hazard of medical insurance. Asymmetric information is the source of moral hazard, and the study of medical insurance moral risk should start with asymmetric information. Through theoretical analysis, we believe that asymmetric information exists in almost all fields of human life, and its influence on its field should be understood from two aspects: positive and negative. In the economic field, asymmetric information will produce different effects due to the market environment: in the competitive environment, the probability of occurrence of moral hazard is suppressed effectively, asymmetric information can be formed, and the game is to promote effective competition, have a positive impact on the environment; disorderly competition, caused by adverse selection, information the moral hazard problem of asymmetric will cause substantial harm to the legitimate income one party in the contract or the parties suffered the loss of unreasonable, negative influence. The one-sided understanding of asymmetric information will lead people to pursue the optimal system design in order to eliminate moral hazard. Instead, it is easy to neglect the necessity of building moral hazard prevention and control mechanism. The correct understanding and understanding of asymmetric information and moral risk is an important basis for the research on the prevention and control mechanism of medical insurance moral hazard. Due to the design of the system of social medical insurance system of our country by country, to pay medical expenses by three units and individuals, the medical and health services in the main market the number of far more than other social insurance programs, so the medical field of moral hazard risk level is very high, by all kinds of factors caused by the moral risks of the Medicare card cash and excessive examination, prescription, medical disputes and other medical services market chaos frequent. These phenomena can occur, one is due to the presence of system design, market trading rules need to continue to improve the structural design of vulnerability and the need to complete the space, on the other hand is due to the lack of effective moral risk prevention and control mechanism of current social medical insurance system. The existence of these factors makes the participants in the medical insurance market easy to carry out dishonesty in the drive of desire for profit, thus causing moral hazard. It can be seen that the existing system design and market structure can not effectively prevent and control the medical insurance moral hazard. At present, the dishonesty of the medical insurance market has been banned repeatedly, and the gap between the actual state and the deserved state is huge. On the basis of deep digging its causes, it is the focus of this study to put forward the ideas and Countermeasures to reduce the gap and solve the problems. The study of social capital from the 70s of the last century pointed out that honesty is not only an endogenous moral concept, but also a kind of externalized social capital. Under the background of frequent failures in the field of medical insurance, it is of special practical significance to explore how to apply the integrity of social capital to the long-term prevention and control mechanism of medical insurance risk. This study will focus on the following aspects: first, there are basic causes of dishonesty in the field of social medical insurance. The problem of medical insurance dishonesty is widely harmful. It is the foundation to explore the path of solving the problem by analyzing the causes of the loss of credit. Second, the factors affecting the production and development of medical insurance moral hazard. Moral risk is a kind of risk. There is a completely different risk state between risk and risk. The real impact is quite different. It is very important to clarify the internal mechanism of moral hazard and study the prevention and control of moral hazard. Third, the essence of asymmetric information phenomenon and its practical significance. To trace the problem of moral hazard is the need to find out the essence of the problem
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R197.1;F842.684
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本文编号：1340806