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医疗保险领域道德风险高发主要是由于个人投入之后,就诊费用由第三方付费;防控及惩罚制度的错位,医疗保险道德风险收益/支出比很大;医疗救治过程负熵信息的累积、诱导;诊疗标准个性特征明显,救治过程与愈后监管难度大;社会医疗保险领域特有的道德风险损害导致直接利益主体缺失。应在医疗保险模式设计、医疗保险宣传教育机制建设、医疗保险基金使用过程中的控制机制、在保险法律规范内逐步展开直接参与医疗保险诊疗环节等四个方面建立医疗保险道德风险高发控制机制。
The high moral hazard in the field of medical insurance is mainly due to the third party paying for medical treatment after individual investment; the misplaced prevention and punishment system has a large moral hazard benefit / expenditure ratio; the accumulation and induction of negative entropy information in the medical treatment process; The standard of diagnosis and treatment has obvious personality characteristics, and the treatment process and the supervision after the cure are more difficult. The damage of moral hazard peculiar to the social medical insurance leads to the lack of direct interest. We should set up a high risk control mechanism for medical insurance in four aspects: the design of medical insurance model, the construction of medical insurance publicity and education mechanism, the control mechanism during the use of medical insurance fund and the step-by-step direct participation in medical insurance in the legal norms of insurance.