从医疗信息化发展看医疗保险中的道德风险管理

Wenzhen Li, Yu-ling Song
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引用次数: 1

摘要

本研究的主题是从医疗信息化发展的角度,探讨如何管理道德风险,保持医疗保险的效率,降低医疗费用。作者对中国医疗费用增长的问题、医疗保险道德风险的概念以及医疗保险道德风险产生的原因进行了细致的考察。分析了中国医疗信息化的发展历程和医疗保险信息系统的功能。对大量交叉数据的综合信息系统在医疗保险中的应用提出了疑问。本文采用了理论和实证两个层面的科学认知方法。本研究的理论基础是由国内外学者关于医疗保险道德风险问题的著作构成的。医疗服务信息化背景下医疗保险道德风险管理模式的发展,是其创新性的体现。医疗保险中的道德风险与保险主体的信息不对称密切相关。医疗信息化已成为医疗保险道德风险管理的重要手段,在提高医疗机构工作效率方面具有广阔的前景。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Managing moral risks in medical insurance from the perspective of development of medical informatization
The subject of this research is the methods of managing moral risks from the perspective of development of medical informatization, which allows maintain efficiency of medical insurance and lowering medical expenses. The authors meticulously examine the problem of growing medical expenses in China, concept of moral risk in medical insurance, as well as causes for emergence of moral risk in medical insurance. Analysis is conducted on the history of development of medical informatization and functionality of information system of medical insurance in China. The question as raised on application of general information system of gathering vast amounts of intersecting data in medical insurance. The article employs method of scientific cognition of theoretical and empirical levels. The theoretical base for this research is comprised of works of Chinese and foreign scholars on the issues of moral risks in medical insurance. The scientific novelty consists in development of a moral risk management model in medical insurance on the background of informatization of medical service. A conclusion is made that moral risks in medical insurance are tightly connected with the asymmetry of information in subjects of insuring. Medical informatization became a very important means for moral risk management in medical insurance and has great prospects for increasing efficiency of the work of medical facilities.
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