高参合率下新型农村合作医疗保险制度道德风险研究.doc

广东金融学院 2009-JX- 谭炳玮 本科毕业论文（设计） 高参合率下新型农村合作医疗保险制度道德风险研究 摘 要 新型农村合作医疗保险制度工作已经进入全面开展阶段。广东目前已经呈现高参合率的态势，高参合率下将会引发一系列问题，如道德风险。新型农村合作医疗保险道德风险主要表现为骗赔、浪费医疗资源、套取医疗基金等。这将会威胁基金安全，降低医疗保障水平、浪费资源甚至滋生犯罪。而新型农村合作医疗保险制度道德风险的成因主要有信息不对称、筹资比例失衡、监管力度缺乏等。为此，必须采取措施规避高参合率下的道德风险。具体措施有引导商业保险参与新型农村合作医疗、调整筹资比例、加强信息化建设和加强政府监管力度。 关键词：新型农村合作医疗保险制度； 高参合率； 道德风险； 加剧；规避 Abstract The work of new rural cooperative medical insurance system has undergone a complete stage.At present,Guangdong has taken on a situation that many people participate in the program,resulting in a series of problems such as moality.The problems of morality that caused by the insurance system mainly are receiving compensation by cheating, wasting medical resource and withdrawing medical funds,so and forth, which will threaten the safty of medical funds,degrade the level of medical quality,waste resource and even be the breedbed of criminalities.While the main contributing factors of problems of morality brought by the new insurance system are wrong information,unbalance financing proprotion as well as insufficient upervision.Therefore,exact measures,for example,strengthening government supervision and informational establishment as well asadjusting financing proprotion and leading commercial insurance takes part in the new rural coopertive medical insurance, should be taken to avoid this type of potential problems. Key words： 目 录 摘 要……………………………………………………………………Ⅰ Abstract……………………………………………………………………Ⅱ 一、前言………………………………………………………………………1 ㈠ 合作医疗概述……………………………………………………………1 ㈡ 新型农村合作医疗保险制度……………………………………………1 ㈢ 高参合率的界定…………………………………………………………1 二、广东新农合情况……………………………………………………2 ㈠ 整体呈现高参合率趋势…………………………………………………3 ㈡ 各市参合情况…………………………………………………………3 ㈢ 高参合率下引发的风险…………………………………………………5 三、新农合道德风险的表现…………………………………………………5 ㈠ 患者道德风险……………………………………………………………5 ㈡ 医疗机构道德风险………………………………………………………6 ㈢ 经办机构道德风险………………………………………………………7 四、新农合道德风险带来的危害……………………………………………7 ㈠ 威胁基金安全……………………………………………………………7 ㈡ 降低保障水平……………………………………………………………8 ㈢ 加剧资源浪费程度………………………………………………………