本文關(guān)鍵詞：誠(chéng)信體系：防控社會(huì)醫(yī)療保險(xiǎn)道德風(fēng)險(xiǎn)的理性選擇　出處：《吉林大學(xué)》2017年博士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 社會(huì)醫(yī)療保險(xiǎn) 信息不對(duì)稱 道德風(fēng)險(xiǎn) 誠(chéng)信體系

【摘要】：當(dāng)下,在我國(guó)醫(yī)療服務(wù)市場(chǎng)中廣泛存在過(guò)度醫(yī)療、醫(yī)保套現(xiàn)等失信現(xiàn)象,社會(huì)醫(yī)療保險(xiǎn)的制度安全受到嚴(yán)重威脅。這些失信現(xiàn)象的發(fā)生具有普遍性和多樣性,其背后的影響因素極為復(fù)雜。對(duì)效用的過(guò)度追求是人們失信的根本動(dòng)機(jī),失信亂象實(shí)為各類(lèi)因素引發(fā)醫(yī)保領(lǐng)域中道德風(fēng)險(xiǎn)的具體表現(xiàn)。面對(duì)由道德風(fēng)險(xiǎn)引發(fā)失信亂象所致的醫(yī)保領(lǐng)域誠(chéng)信缺失現(xiàn)狀,在頂層設(shè)計(jì)中不斷完善和優(yōu)化制度的基礎(chǔ)上,運(yùn)用誠(chéng)信社會(huì)資本構(gòu)建社會(huì)醫(yī)療保險(xiǎn)道德風(fēng)險(xiǎn)長(zhǎng)效防控機(jī)制,是治理醫(yī)保領(lǐng)域失信亂象頻發(fā)、提高醫(yī)療服務(wù)市場(chǎng)誠(chéng)信水平、維護(hù)醫(yī)療服務(wù)市場(chǎng)運(yùn)營(yíng)秩序、保護(hù)社會(huì)醫(yī)療保險(xiǎn)制度安全運(yùn)行的理性選擇。美國(guó)著名經(jīng)濟(jì)學(xué)家肯尼斯·阿羅(Kenneth J.Arrow)于上世紀(jì)60年代首次提出道德風(fēng)險(xiǎn)這一微觀經(jīng)濟(jì)學(xué)經(jīng)典概念,此后經(jīng)諸多學(xué)者對(duì)其不斷進(jìn)行深入研究,得出結(jié)論,認(rèn)為道德風(fēng)險(xiǎn)是因信息不對(duì)稱(亦稱為非對(duì)稱信息)而產(chǎn)生的系統(tǒng)性風(fēng)險(xiǎn),屬于一種不可保風(fēng)險(xiǎn),且具有不可消除性。作為一種與道德有一定關(guān)系的風(fēng)險(xiǎn),道德風(fēng)險(xiǎn)并不等同于道德敗壞。從風(fēng)險(xiǎn)發(fā)展變化的過(guò)程看,道德風(fēng)險(xiǎn)的產(chǎn)生和存在與人們的倫理道德無(wú)關(guān),道德風(fēng)險(xiǎn)的發(fā)生則在一定程度上受到道德的影響。道德風(fēng)險(xiǎn)與逆向選擇被認(rèn)為是由于經(jīng)濟(jì)市場(chǎng)交易活動(dòng)中存在的非對(duì)稱信息現(xiàn)象導(dǎo)致的,其對(duì)交易合同契約造成的負(fù)面影響一般因失信行為種類(lèi)繁多而程度不一,但道德風(fēng)險(xiǎn)與逆向選擇對(duì)保險(xiǎn)行業(yè)——尤其是前者對(duì)于社會(huì)保險(xiǎn)制度體系的安全運(yùn)行造成很大威脅。當(dāng)前在社會(huì)醫(yī)療保險(xiǎn)領(lǐng)域中存在的大量失信現(xiàn)象,實(shí)際上是各類(lèi)相關(guān)因素誘發(fā)道德風(fēng)險(xiǎn)而產(chǎn)生的。因此,醫(yī)保領(lǐng)域中的失信現(xiàn)象是醫(yī)保道德風(fēng)險(xiǎn)發(fā)生的具體表現(xiàn)。非對(duì)稱信息是道德風(fēng)險(xiǎn)產(chǎn)生的根源,對(duì)醫(yī)保道德風(fēng)險(xiǎn)的研究則應(yīng)當(dāng)從非對(duì)稱信息入手。通過(guò)理論分析,本文認(rèn)為,非對(duì)稱信息恒常存在于人類(lèi)生活幾乎所有領(lǐng)域之中,其對(duì)所在領(lǐng)域產(chǎn)生的影響應(yīng)從積極和消極兩個(gè)方面理解。在經(jīng)濟(jì)領(lǐng)域中,非對(duì)稱信息會(huì)因市場(chǎng)環(huán)境的優(yōu)劣而產(chǎn)生不同的影響:在有序競(jìng)爭(zhēng)環(huán)境中,道德風(fēng)險(xiǎn)發(fā)生的概率被有效抑制,非對(duì)稱信息能夠形成正和博弈、促進(jìn)有效競(jìng)爭(zhēng),產(chǎn)生積極影響;在無(wú)序競(jìng)爭(zhēng)環(huán)境中,非對(duì)稱信息所引起的逆向選擇、道德風(fēng)險(xiǎn)等問(wèn)題將造成實(shí)質(zhì)性危害,使契約中的一方或多方的正當(dāng)收益蒙受不合理的損失,產(chǎn)生消極影響。對(duì)非對(duì)稱信息的片面理解將導(dǎo)致人們?yōu)橄赖嘛L(fēng)險(xiǎn)而過(guò)度追求最優(yōu)制度設(shè)計(jì),反而容易忽視構(gòu)建道德風(fēng)險(xiǎn)防控機(jī)制的必要性。正確理解和認(rèn)識(shí)非對(duì)稱信息與道德風(fēng)險(xiǎn),是醫(yī)保道德風(fēng)險(xiǎn)防控機(jī)制研究工作的重要基礎(chǔ)。由于我國(guó)社會(huì)醫(yī)療保險(xiǎn)制度采用國(guó)家、用人單位和個(gè)人三方共同支付醫(yī)療費(fèi)用的制度設(shè)計(jì),使得醫(yī)療衛(wèi)生服務(wù)市場(chǎng)的參與主體數(shù)量遠(yuǎn)多于其他社會(huì)保險(xiǎn)項(xiàng)目,因而醫(yī)保領(lǐng)域道德風(fēng)險(xiǎn)的風(fēng)險(xiǎn)水平極高,由各類(lèi)因素引發(fā)道德風(fēng)險(xiǎn)所產(chǎn)生的醫(yī)保卡套現(xiàn)、過(guò)度檢查、開(kāi)大處方、醫(yī)患糾紛等醫(yī)療服務(wù)市場(chǎng)亂象頻發(fā)。這些不誠(chéng)信現(xiàn)象之所以能夠發(fā)生,一方面是由于制度設(shè)計(jì)、市場(chǎng)交易規(guī)則設(shè)計(jì)存在需要繼續(xù)完善的空間和亟需補(bǔ)全的結(jié)構(gòu)性漏洞,另一方面則是由于當(dāng)前社會(huì)醫(yī)療保險(xiǎn)制度體系中缺乏有效的道德風(fēng)險(xiǎn)防控機(jī)制。這些因素的存在,使得醫(yī)保市場(chǎng)參與主體易于在逐利欲望的驅(qū)使下施行不誠(chéng)信行為,從而引發(fā)道德風(fēng)險(xiǎn)。由此可見(jiàn),現(xiàn)有的制度設(shè)計(jì)和市場(chǎng)結(jié)構(gòu),顯然無(wú)法有效防控醫(yī)保道德風(fēng)險(xiǎn)。目前我國(guó)醫(yī)保市場(chǎng)失信行為屢禁不止,實(shí)然狀態(tài)與應(yīng)然狀態(tài)之間差距巨大。在深挖其成因的基礎(chǔ)上,提出縮小差距解決問(wèn)題的思路和對(duì)策,是本項(xiàng)研究的重點(diǎn)。始于上個(gè)世紀(jì)70年代的社會(huì)資本理論研究指出,誠(chéng)信不僅是一種內(nèi)生的道德理念,更是一種可以外化的社會(huì)資本。在醫(yī)保領(lǐng)域失信亂象頻發(fā)的背景下,探討如何將誠(chéng)信社會(huì)資本運(yùn)用于建設(shè)醫(yī)保道德風(fēng)險(xiǎn)長(zhǎng)效防控機(jī)制,具有特別現(xiàn)實(shí)的積極意義。本項(xiàng)研究將重點(diǎn)圍繞以下幾個(gè)方面展開(kāi):第一,社會(huì)醫(yī)療保險(xiǎn)領(lǐng)域存在失信亂象的基本成因。醫(yī)保失信問(wèn)題的廣泛出現(xiàn)危害極大,通過(guò)梳理失信表現(xiàn)分析其成因,是從根本上探尋解決問(wèn)題路徑的基礎(chǔ)。第二,醫(yī)保道德風(fēng)險(xiǎn)產(chǎn)生和發(fā)展過(guò)程的影響因素。道德風(fēng)險(xiǎn)屬于風(fēng)險(xiǎn)的一種,風(fēng)險(xiǎn)存在與風(fēng)險(xiǎn)發(fā)生是截然不同的風(fēng)險(xiǎn)狀態(tài),其實(shí)際影響有著天壤之別,明晰道德風(fēng)險(xiǎn)發(fā)生過(guò)程的內(nèi)在機(jī)理,對(duì)道德風(fēng)險(xiǎn)防控研究意義重大。第三,非對(duì)稱信息現(xiàn)象恒常存在的本質(zhì)及其現(xiàn)實(shí)意義。對(duì)道德風(fēng)險(xiǎn)問(wèn)題追根溯源,是摸清問(wèn)題本質(zhì)的需要,對(duì)非對(duì)稱信息、道德風(fēng)險(xiǎn)等概念的正確理解是尋找醫(yī)保道德風(fēng)險(xiǎn)防控路徑的根本出發(fā)點(diǎn)。第四,誠(chéng)信作為一種傳統(tǒng)意義上的道德概念,能否外化為社會(huì)資本并用于社會(huì)治理問(wèn)題。誠(chéng)信是中華傳統(tǒng)文化的瑰寶,是信任實(shí)現(xiàn)的基礎(chǔ)。運(yùn)用誠(chéng)信社會(huì)資本構(gòu)建醫(yī)保道德風(fēng)險(xiǎn)防控機(jī)制,在理論層面、實(shí)踐層面是否具有科學(xué)性和有效性,值得深入研究。第五,構(gòu)建社會(huì)醫(yī)療保險(xiǎn)誠(chéng)信體系對(duì)于防控醫(yī)保道德風(fēng)險(xiǎn)的必要性。不斷完善和優(yōu)化現(xiàn)有制度是規(guī)避道德風(fēng)險(xiǎn)的重要手段,但僅僅依賴制度層面的努力是遠(yuǎn)遠(yuǎn)不夠的,實(shí)踐層面道德風(fēng)險(xiǎn)防控機(jī)制的缺失是不爭(zhēng)的事實(shí)。第六,醫(yī)保誠(chéng)信體系的框架結(jié)構(gòu)和內(nèi)容。經(jīng)驗(yàn)證明,任何一項(xiàng)制度體系的建構(gòu),都是在特定理論的指導(dǎo)下展開(kāi)的,其結(jié)構(gòu)和內(nèi)容應(yīng)具有系統(tǒng)性、科學(xué)性。第七,社會(huì)醫(yī)療保險(xiǎn)誠(chéng)信體系防控醫(yī)保道德風(fēng)險(xiǎn)的有效性問(wèn)題。醫(yī)保誠(chéng)信體系的結(jié)構(gòu)設(shè)計(jì)應(yīng)當(dāng)做到既符合理論研究要求,又能夠滿足實(shí)踐工作的需要。社會(huì)保障作為一門(mén)綜合性應(yīng)用學(xué)科,其研究工作不僅應(yīng)在理論層面有所突破,更要求研究成果能夠?qū)ι鐣?huì)保障制度實(shí)踐提供幫助。本文以中外非對(duì)稱信息、道德風(fēng)險(xiǎn)、誠(chéng)信等理論研究為基礎(chǔ),結(jié)合醫(yī)保誠(chéng)信缺失等實(shí)然現(xiàn)狀,對(duì)醫(yī)保道德風(fēng)險(xiǎn)問(wèn)題進(jìn)行了深入的理論研究,通過(guò)分析信息不對(duì)稱、人的社會(huì)化、道德風(fēng)險(xiǎn)之間的作用機(jī)理,指出了在醫(yī)保道德風(fēng)險(xiǎn)治理中引入誠(chéng)信社會(huì)資本進(jìn)行防控機(jī)制建設(shè)的必要性,最后對(duì)社會(huì)醫(yī)療保險(xiǎn)誠(chéng)信體系的框架結(jié)構(gòu)進(jìn)行了科學(xué)設(shè)計(jì),并分析了其滿足理論研究要求和實(shí)踐工作需要的有效性。
[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
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R197.1;F842.684
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本文編號(hào)：1340806