本文選題：商業(yè)醫(yī)療保險 + 風險��； 參考：《蘇州大學(xué)》2013年碩士論文

【摘要】：近年來，隨著中央政府對民生問題關(guān)注度的逐步提高，解決群眾醫(yī)療衛(wèi)生問題作為保障民生的基本內(nèi)容也得到了相應(yīng)的重視，各級政府在相關(guān)決策中紛紛強調(diào)了居民健康問題的重要性，同時加大了對當?shù)氐尼t(yī)療衛(wèi)生投入。2009年4月，《中共中央國務(wù)院關(guān)于深化醫(yī)藥衛(wèi)生體制改革的意見》出臺，該方案鼓勵企業(yè)和個人積極參與商業(yè)醫(yī)療保險，以滿足人民群眾對基本醫(yī)療保障之外的健康保險需求。這樣一來，各級政府對居民醫(yī)療健康這一問題的高度重視為商業(yè)醫(yī)療保險的發(fā)展提供了政策支持，而新醫(yī)藥體制改革又從制度定位、發(fā)展方向、實現(xiàn)方式等方面為我國商業(yè)醫(yī)療保險提供了良好的發(fā)展空間。 商業(yè)醫(yī)療保險作為醫(yī)療保障體系的構(gòu)成部分，是對社會醫(yī)療保險的重要補充，在人口老齡化加劇、新的醫(yī)療設(shè)備和技術(shù)層出不窮的情況下，它可以滿足人們?nèi)找嬖鲩L的醫(yī)療服務(wù)需求，其作用不可忽視。近幾年我國的商業(yè)醫(yī)療保險市場保持著較快的發(fā)展水平，醫(yī)療保險經(jīng)營主體數(shù)量不斷增加，產(chǎn)品種類繁多，覆蓋面逐步擴大，但與人們的迫切需求相比，其發(fā)展還相對緩慢，發(fā)展過程中也顯現(xiàn)出一些問題，風險客觀存在。目前，缺少商業(yè)醫(yī)療保險風險控制方法已成為制約我國整個醫(yī)療保險發(fā)展的瓶頸，商業(yè)醫(yī)療保險經(jīng)營成敗的關(guān)鍵就在于能否做好風險控制工作。我國醫(yī)療保險尚處于初級發(fā)展階段，，有關(guān)商業(yè)醫(yī)療保險風險及控制的研究才開始萌芽，為了促進我國商業(yè)醫(yī)療保險快速發(fā)展，必須對其存在的風險加以分析研究，并采取相應(yīng)的措施來控制風險。 本文以商業(yè)醫(yī)療保險的風險及風險控制為核心研究內(nèi)容，綜合運用保險學(xué)、信息不對稱理論、博弈論等理論知識和方法，結(jié)合目前我國商業(yè)醫(yī)療保險發(fā)展現(xiàn)狀及存在的問題，分析醫(yī)療保險市場存在的道德風險、逆向選擇風險、費用支付方式風險和產(chǎn)品設(shè)計風險產(chǎn)生的原因、表現(xiàn)形式及危害，并運用博弈模型對道德風險進行了重點研究。通過分析國內(nèi)商業(yè)醫(yī)療保險風險控制機制及其存在的問題，在借鑒國外經(jīng)驗和前人研究的基礎(chǔ)上，本文提出了一系列符合我國商業(yè)醫(yī)療保險發(fā)展的風險控制思路和方法，包括推行管理式醫(yī)療模式、促進社會醫(yī)療保險與商業(yè)醫(yī)療保險之間的有效銜接、改進賠付結(jié)算方式、推廣創(chuàng)新產(chǎn)品的設(shè)計等。
[Abstract]:In recent years, with the increasing attention of the central government on people's livelihood issues, solving the mass medical and health problems, as the basic content of protecting people's livelihood, has been given corresponding attention.Governments at all levels have emphasized the importance of residents' health problems and increased their investment in local medical and health care. In April 2009, the State Council of the CPC Central Committee and the State Council on deepening the reform of the medical and health system came out.The program encourages businesses and individuals to participate actively in commercial health insurance to meet people's needs for health insurance beyond basic health insurance.As a result, governments at all levels attached great importance to the issue of residents' medical care and health care, which provided policy support for the development of commercial medical insurance, and the reform of the new medical system was based on the orientation of the system and the direction of development.The realization way and so on has provided the good development space for our country commercial medical insurance.As an integral part of the medical security system, commercial medical insurance is an important supplement to social medical insurance. With the aging of the population and the emergence of new medical equipment and technology,It can meet the increasing demand of medical service, and its function can not be ignored.In recent years, China's commercial medical insurance market has maintained a relatively rapid development level. The number of medical insurance operators has been increasing, the products are various, the coverage is gradually expanding, but compared with the urgent needs of people, the development of medical insurance is relatively slow.In the process of development, there are some problems and risks exist objectively.At present, the lack of commercial medical insurance risk control method has become a bottleneck restricting the development of medical insurance in China. The key to the success or failure of commercial medical insurance management lies in whether or not to do a good job of risk control.China's medical insurance is still in the primary stage of development, and the research on the risk and control of commercial medical insurance has just begun to sprout. In order to promote the rapid development of our country's commercial medical insurance, it is necessary to analyze and study its existing risks.And take appropriate measures to control the risk.This article takes the risk and risk control of commercial medical insurance as the core research content, synthetically uses the insurance science, the information asymmetry theory, the game theory and so on the theory knowledge and the method, unifies our country commercial medical insurance development present situation and the existence question at present.This paper analyzes the causes, forms and harms of moral hazard, adverse selection risk, expense payment risk and product design risk in the medical insurance market, and focuses on the study of moral hazard by using the game model.By analyzing the risk control mechanism of domestic commercial medical insurance and its existing problems, this paper puts forward a series of ideas and methods of risk control in line with the development of commercial medical insurance in China on the basis of foreign experience and previous studies.It includes promoting the effective link between social medical insurance and commercial medical insurance, improving the settlement method of compensation, and popularizing the design of innovative products.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：F842.684

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本文編號：1745460