健康保险是当今世界解决个人医疗费用负担的最为有效的方法之一。然而,在经营健康保险过程中,保险公司面临许多风险: 保险公司、被保险人和医疗服务提供者三方在追求各自利益最大化时的冲突是风险产生的根本原因。对经营健康保险的风险进行控制,主要就是对医疗费用进行有效的控制。由于长期以来医疗部门存在垄断,加之我国人口众多,使医疗部门始终处于“卖方市场”。在保险合同规定投保人、被保险人与 Health insurance is one of the most effective ways in the world to address the burden of individual medical bills. However, insurance companies face many risks in the operation of health insurance: the conflict between insurance companies, insureds and healthcare providers seeking the maximum benefit of each is the root cause of the risk. The main control over the risk of operating health insurance is the effective control of medical expenses. Due to the monopoly of the medical sector over a long period of time and the large population in our country, the medical sector has always been in the “seller’s market.” In the insurance contract provides that the insured, the insured and