我国商业医疗保险风险防范制度分析

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1、山东大学硕士学位论文Commercialmedicalinsurancedevelopmentpath,notoutofthebackgroundisthechangesofthegovernmentorganizationofmedicMsecuritysystem．Commercialmedicalinsurancetoparticipateinthenationalhealthinsuranceindustrysystemconstructionhasthreeimportantrolesthatist

2、hemainproviderofaddedsecuritycompetitors，medicalinsurance，basichealthca托institutionsandhealthserviceagenciesrelationshipexplorers．Therefore，thecommercialmedicalinsuranceriskpreventionoffurtherresearch,buildingperfectlegalsystemofthecommercialmedicalinsuranc

3、eriskprevention，isnotonlytheneedsofthedevelopmentofcommercialmedicalinsuranceitself,alsohasimportantsignificancefortheconstructionofmedicalsecuritysysteminourcountry．Commercialhealthinsurancemeansthatwhentheinsuredpersonsuffersomediseaseorinjuriesduetoaresu

4、ltofmedicalexpensesthatexpensespaidbytheinsurer．Duetohealthcannotbemeasuredasgeneralmerchandise，makingcommercialhealthinsurancestrictlydistinguishedfi'omothertypesofinsurance，riskisnoteasytojudge．Theserisksmaycome丘Dmtheeconomic，thelegalandpolicyfactors．Thee

5、xistingfl"ameisnotcompleteinourcountry,coupledwithimperfectinformationdisclosuresystem，creditsystemandtheregulatorysystemofinsurancefunds，providingtheopportunitytopractitionerstomanipulatemarket．Therefore，tosolvetheseproblems，OUrcountrymustimprovetherelevan

6、tlegalsystem．U．S．managedcare，specializedoperationsinGermanyandtheNetherlandshavealegalsystemconstructioninthemanagememofthemedicalmodelofcompetitionalsoprovidesasuccessfulexperienceforOUrcountry．Inthispaper,weadvocatethelegislation,judicialsystem，regulatory

7、andpolicysystemfouraspectstopreventcommercialmedicalinsuranceriskandimprovethelegalsystem．First，weshouldstrengthenthe”BusmessHealthInsuranceLaw”andrelevantlawsandregulationssystem．Weshouldestablishaclearlegaldefinitionofcommercialhealthinsurance，theinsuranc

8、ecreditlawsandregulations，theinsurancepremiumrefundsystem．Inthejudicialsystem，weshouldimprovethe2山东大学硕士学位论文professionalismofmedicalinsurancedisputeresolutionmechanismsandstrengthenthenormativeconstruct