社會醫(yī)療保險中醫(yī)生道德風(fēng)險的決定因素及防范研究
發(fā)布時間：2019-01-30 07:39
【摘要】：為了解決人民防病治病問題我國確立了社會醫(yī)療保險制度,但是制度中存在很多問題,例如信息不對稱、以藥養(yǎng)醫(yī)以及第三方支付等等,在制度保護下醫(yī)生作為醫(yī)療服務(wù)提供方卻為了個人利益,利用自身優(yōu)勢從事道德風(fēng)險活動。醫(yī)生的道德風(fēng)險行為會產(chǎn)生較多的資源浪費,加劇醫(yī)療費用的不合理增長,破壞醫(yī)生與患者之間關(guān)系,對醫(yī)療保險發(fā)展的可持續(xù)性是一種挑戰(zhàn),同時威脅著社會的安定、和諧。然而僅僅解決社會醫(yī)療保險中的信息不對稱或者疾病不確定等問題,并不能很好的防范醫(yī)生道德風(fēng)險。因此,有必要分析社會醫(yī)療保險中醫(yī)生道德風(fēng)險的影響因素,并依據(jù)這些影響因素提出切實可行的防范措施,實現(xiàn)社會醫(yī)療保險保障人民生命健康的目的,進而實現(xiàn)社會醫(yī)療保險的持續(xù)發(fā)展。本文首先論述了研究背景及意義,對國內(nèi)外文獻進行綜述,并介紹了本文的研究方法、內(nèi)容以及創(chuàng)新點,確定了整體研究方向。其次對社會醫(yī)療保險中醫(yī)生道德風(fēng)險的相關(guān)概念、表現(xiàn)和特征進行詳細的闡述,分析了社會醫(yī)療保險中道德風(fēng)險的演變,并對本文所用到的委托代理理論和博弈論進行了簡單介紹,明確相關(guān)概念及理論之后將進行下一步分析。接著重點以定點醫(yī)院醫(yī)生為研究對象,通過訪談發(fā)現(xiàn)影響醫(yī)生道德風(fēng)險的因素并不僅僅只有醫(yī)生這一主體。對訪談獲得的數(shù)據(jù)進行編碼整理可以發(fā)現(xiàn),醫(yī)生道德風(fēng)險涉及五大利益相關(guān)主體,這些主體都直接或間接的影響著醫(yī)生道德風(fēng)險行為,對影響因素進行條目數(shù)比較,可以得出其中相對重要的具體因素為下一步的分析奠定基礎(chǔ)。之后就針對訪談結(jié)果進行分析,找出影響因素中的決定因素,并做博弈分析。對五大主體中影響醫(yī)生道德風(fēng)險程度的具體因素建立數(shù)據(jù)模型,得出政府、定點醫(yī)院以及患者的監(jiān)督是社會醫(yī)療保險中醫(yī)生道德風(fēng)險的決定因素,并對決定因素進行博弈論分析。最后,針對這些調(diào)研及分析結(jié)果,從五大主體視角闡釋了以主體監(jiān)督為主的全方位醫(yī)生道德風(fēng)險防范措施。本文采用文獻研究、訪談與博弈論分析相結(jié)合的方法,對社會醫(yī)療保險中醫(yī)生道德風(fēng)險的影響因素進行了系統(tǒng)分析,提出了一些具體的防范措施。本文在研究視角及研究內(nèi)容上有一定創(chuàng)新,選擇與以往研究不同的視角來分析醫(yī)生道德風(fēng)險問題,從利益相關(guān)主體的視角來看待這一問題,剖析其中的主要影響因素;并對醫(yī)生道德風(fēng)險防范措施提出了一些獨立見解,力求規(guī)范利益相關(guān)主體的行為,調(diào)動醫(yī)生的主體性和積極性,建立一個和諧、信任的醫(yī)療環(huán)境。
[Abstract]:In order to solve the problem of people's disease prevention and treatment, China has established a social medical insurance system. However, there are many problems in the system, such as information asymmetry, medical care with drugs, third party payments, and so on. Under the protection of the system, doctors, as providers of medical services, take advantage of their own advantages to engage in moral hazard activities for their personal benefit. The moral hazard behavior of doctors will cause more waste of resources, aggravate the unreasonable increase of medical expenses, destroy the relationship between doctors and patients, and it is a challenge to the sustainability of the development of medical insurance, at the same time, it threatens the stability and harmony of the society. However, solving the problems of information asymmetry or disease uncertainty in social medical insurance is not a good way to prevent doctors' moral hazard. Therefore, it is necessary to analyze the influencing factors of doctors' moral hazard in social medical insurance, and put forward feasible preventive measures according to these influencing factors, so as to realize the purpose of social medical insurance to protect people's life and health. Then realize the sustainable development of social medical insurance. This paper first discusses the research background and significance, summarizes the literature at home and abroad, and introduces the research methods, contents and innovations of this paper, and determines the overall research direction. Secondly, the related concepts, manifestations and characteristics of doctors' moral hazard in social medical insurance are expounded in detail, and the evolution of moral hazard in social medical insurance is analyzed. The principal-agent theory and game theory used in this paper are briefly introduced, and the related concepts and theories will be further analyzed. Then it focuses on the doctors in designated hospitals, and finds out that doctors are not the only factors that affect the moral hazard of doctors through interviews. After coding the data obtained from the interview, we can find that the moral hazard of doctors involves five stakeholders, who directly or indirectly affect the behavior of moral hazard of doctors, and compare the number of items of the influencing factors. It can be concluded that one of the relatively important specific factors for the next analysis laid the foundation. Then we analyze the results of the interview, find out the determinants of the factors, and do game analysis. This paper establishes a data model of the specific factors that affect the degree of doctors' moral hazard in the five main bodies, and concludes that the government, designated hospitals and patients' supervision are the decisive factors of doctors' moral hazard in social medical insurance. And the decisive factors are analyzed by game theory. Finally, according to the results of investigation and analysis, this paper explains the preventive measures of moral hazard of omni-directional doctors from five main points of view. By using the methods of literature research, interview and game theory analysis, this paper makes a systematic analysis of the influencing factors of doctors' moral hazard in social medical insurance, and puts forward some concrete preventive measures. This article has certain innovation in the research angle and the research content, chooses the different angle of view from the previous research to analyze the doctor moral hazard question, looks at this question from the angle of the main body of interest, analyzes the main influence factor; It also puts forward some independent opinions on the prevention measures of doctors' moral hazard, tries to standardize the behavior of stakeholders, arouses the subjectivity and enthusiasm of doctors, and establishes a harmonious and trusted medical environment.
【學(xué)位授予單位】：山東財經(jīng)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R197.1;F842.684
本文編號：2417907
[Abstract]:In order to solve the problem of people's disease prevention and treatment, China has established a social medical insurance system. However, there are many problems in the system, such as information asymmetry, medical care with drugs, third party payments, and so on. Under the protection of the system, doctors, as providers of medical services, take advantage of their own advantages to engage in moral hazard activities for their personal benefit. The moral hazard behavior of doctors will cause more waste of resources, aggravate the unreasonable increase of medical expenses, destroy the relationship between doctors and patients, and it is a challenge to the sustainability of the development of medical insurance, at the same time, it threatens the stability and harmony of the society. However, solving the problems of information asymmetry or disease uncertainty in social medical insurance is not a good way to prevent doctors' moral hazard. Therefore, it is necessary to analyze the influencing factors of doctors' moral hazard in social medical insurance, and put forward feasible preventive measures according to these influencing factors, so as to realize the purpose of social medical insurance to protect people's life and health. Then realize the sustainable development of social medical insurance. This paper first discusses the research background and significance, summarizes the literature at home and abroad, and introduces the research methods, contents and innovations of this paper, and determines the overall research direction. Secondly, the related concepts, manifestations and characteristics of doctors' moral hazard in social medical insurance are expounded in detail, and the evolution of moral hazard in social medical insurance is analyzed. The principal-agent theory and game theory used in this paper are briefly introduced, and the related concepts and theories will be further analyzed. Then it focuses on the doctors in designated hospitals, and finds out that doctors are not the only factors that affect the moral hazard of doctors through interviews. After coding the data obtained from the interview, we can find that the moral hazard of doctors involves five stakeholders, who directly or indirectly affect the behavior of moral hazard of doctors, and compare the number of items of the influencing factors. It can be concluded that one of the relatively important specific factors for the next analysis laid the foundation. Then we analyze the results of the interview, find out the determinants of the factors, and do game analysis. This paper establishes a data model of the specific factors that affect the degree of doctors' moral hazard in the five main bodies, and concludes that the government, designated hospitals and patients' supervision are the decisive factors of doctors' moral hazard in social medical insurance. And the decisive factors are analyzed by game theory. Finally, according to the results of investigation and analysis, this paper explains the preventive measures of moral hazard of omni-directional doctors from five main points of view. By using the methods of literature research, interview and game theory analysis, this paper makes a systematic analysis of the influencing factors of doctors' moral hazard in social medical insurance, and puts forward some concrete preventive measures. This article has certain innovation in the research angle and the research content, chooses the different angle of view from the previous research to analyze the doctor moral hazard question, looks at this question from the angle of the main body of interest, analyzes the main influence factor; It also puts forward some independent opinions on the prevention measures of doctors' moral hazard, tries to standardize the behavior of stakeholders, arouses the subjectivity and enthusiasm of doctors, and establishes a harmonious and trusted medical environment.
【學(xué)位授予單位】：山東財經(jīng)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R197.1;F842.684
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