【摘要】：商業(yè)健康保險的風(fēng)險防范問題不單單關(guān)乎保險公司興衰成敗，而且對社會主義和諧社會的建立，國家經(jīng)濟(jì)社會的穩(wěn)定健康發(fā)展都有著非常重要的作用。本文通過對我國現(xiàn)階段商業(yè)健康保險現(xiàn)狀及問題的深入分析，結(jié)合中國健康保險經(jīng)營的實際情況，借鑒國外商業(yè)健康保險風(fēng)險管理的實際經(jīng)驗和研究成果，結(jié)合我國現(xiàn)階段基本國情，對我國商業(yè)健康保險風(fēng)險防控做出了整體設(shè)計和初步研究，試圖為商業(yè)健康保險的經(jīng)營活動提供參考。 本文運用經(jīng)濟(jì)學(xué)和管理學(xué)的一些研究成果，分析和論證了逆向選擇和道德風(fēng)險經(jīng)濟(jì)學(xué)含義、產(chǎn)生的原因、表現(xiàn)形式以及造成的后果等，指出信息不對稱問題而產(chǎn)生的逆向選擇和道德風(fēng)險現(xiàn)象是阻礙商業(yè)健康保險健康發(fā)展的根本原因，逆向選擇和道德風(fēng)險是保險機(jī)制發(fā)揮作用的最大障礙，并提出了解決此問題的一些方法。最后聯(lián)系美國和巴西的保險管理模式，針對我國的現(xiàn)實國情，提出了防范和控制逆向選擇和道德風(fēng)險的具體措施和可行性方案。 本文第一章闡述了研究的背景、意義、問題的提出，并對國內(nèi)外研究現(xiàn)狀進(jìn)行了回顧和綜述；第二章分析了商業(yè)健康保險的基本概念、市場中各行為主體的特點及信息不對稱問題、分析了商業(yè)健康保險的可保性條件及相關(guān)理論進(jìn)行了論述；第三章主要對商業(yè)健康保險的風(fēng)險現(xiàn)狀及其產(chǎn)生的原因進(jìn)行了分析；第四章研究了美國和巴西等國家的健康醫(yī)療保險模式，對我國來說可以借鑒相關(guān)經(jīng)驗；第五章以逆向選擇和道德風(fēng)險為切入點，，通過對我國商業(yè)健康保險現(xiàn)狀及所處社會經(jīng)濟(jì)環(huán)境的分析，使用信息不對稱理論提出從完善個人健康檔案、健全完善監(jiān)督監(jiān)管力度、建設(shè)專業(yè)化的人才隊伍、健全覆蓋雙方的信用機(jī)制等方面著手來降低商業(yè)健康保險風(fēng)險成因，希望能對我國商業(yè)健康保險制度機(jī)制建設(shè)的快速健康發(fā)展提供參考和啟示；第六章是對全文得出結(jié)論和探討下一步需要研究的問題。
[Abstract]:The risk prevention of commercial health insurance is not only related to the success or failure of insurance companies, but also plays an important role in the establishment of socialist harmonious society and the stable and healthy development of national economy and society. By analyzing the current situation and problems of commercial health insurance in China, combining with the actual situation of health insurance management in China, this paper draws lessons from the practical experience and research results of commercial health insurance risk management in foreign countries. Combined with the basic situation of our country at present, this paper makes an overall design and preliminary study on the risk prevention and control of commercial health insurance in China, and attempts to provide a reference for the business activities of commercial health insurance. Using some research results of economics and management, this paper analyzes and proves the meaning, causes, forms and consequences of adverse selection and moral hazard economics. It is pointed out that adverse selection and moral hazard caused by asymmetric information are the fundamental reasons that hinder the healthy development of commercial health insurance, and reverse selection and moral hazard are the biggest obstacles to the function of insurance mechanism. Some methods to solve this problem are put forward. Finally, according to the actual situation of our country, the concrete measures and feasible schemes of preventing and controlling adverse selection and moral hazard are put forward according to the insurance management mode of the United States and Brazil. The first chapter describes the background, significance and problems of the research, and reviews the current research situation at home and abroad, the second chapter analyzes the basic concepts of commercial health insurance. The characteristics of various actors in the market and the problem of information asymmetry are analyzed, and the insurability conditions of commercial health insurance and related theories are discussed. Chapter three mainly analyzes the risk situation of commercial health insurance and its causes. The fourth chapter studies the health care insurance models of the United States and Brazil, which can be used for reference by our country. Chapter five focuses on adverse selection and moral hazard. Based on the analysis of the present situation of commercial health insurance in China and the social and economic environment in which it is located, and using the theory of asymmetric information, this paper puts forward the following points: perfecting personal health records, perfecting supervision and supervision, and building up specialized talents. Improve the credit mechanism of both sides to reduce the causes of commercial health insurance risk, hoping to provide reference and inspiration for the rapid and healthy development of commercial health insurance system construction in China; The sixth chapter is to draw the conclusion of the full text and to explore the next need to study the problems.
【學(xué)位授予單位】：河南大學(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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