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社会医疗保险中欺诈问题的博弈分析
引用本文:李玮,黄丞,蒋馥.社会医疗保险中欺诈问题的博弈分析[J].上海交通大学学报,2004,38(3):470-473.
作者姓名:李玮  黄丞  蒋馥
作者单位:上海交通大学,安泰管理学院,上海,200052
基金项目:国家自然科学基金资助项目(70003005,70241027),上海交通大学保险培训中心与荷兰保险有限公司联合资助项目
摘    要:建立了社会医疗保险机构同消费者、医疗机构的联合体之间关于保险欺诈的博弈模型,在此基础上研究了博弈达到均衡状态下社会医疗保险合同中各相关参数之间的关系,从而为确定适当的医疗保险合同提供了依据.同时,讨论了保险机构对医疗费用偿付要求的审核监管对保险欺诈行为的影响.并探讨了设立专门审核欺诈行为的社会组织的优越性.

关 键 词:社会医疗保险  欺诈  审核  博弈分析
文章编号:1006-2467(2004)03-0470-04
修稿时间:2002年9月18日

Game Analysis of Fraud in Social Health Insurance System
LI Wei,HUANG Cheng,JIANG Fu.Game Analysis of Fraud in Social Health Insurance System[J].Journal of Shanghai Jiaotong University,2004,38(3):470-473.
Authors:LI Wei  HUANG Cheng  JIANG Fu
Abstract:This paper established a game model of fraud between social health insurance institutions and the community of consumers and health care institutions. Based on it, the relationship of relevant parameters of the social health insurance contracts in equilibrium was researched. It is helpful in setting up proper insurance contracts. At the same time, this paper discussed the effects of insurance institutions' audits for the requirements of medical expenditure payoff on insurance fraud. Finally, it simply analyzed the advantages of special social organization that is designed to audit the fraud of health insurance.
Keywords:social health insurance  fraud  audit  game analysis
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