The Study of Social Medical Insurance Fraud Based on Cost-Benefit Theory
|Keywords||Social Medical Insurance Fraud Behavior Cost-Benefit Theory Structural Equation Model|
Social medical insurance system is an important security system for solving "high medical expense" problem. The mechanism of social medical insurance system’s effective running is a big issue to people’s livelihood. But in recent years there are many problems in China’s social medical insurance system’s running. The extrusive one is social medical insurance fraud. Social medical insurance fraud increases social medical insurance system’s running cost and threatens Social medical insurance system’s effective running seriously. In this situation, obviously, a research of social medical insurance fraud is needed.This paper brings in the cost-benefit theory to investigate the social medical insurance fraud, analyzes social medical insurance fraud and anti-fraud behavior’s cost and benefit, and compares the components of each participant’s cost and benefit in medical insurance system Based on expected utility theory and cost-benefit theory, this paper creates social medical insurance fraud behavior and anti-fraud behavior’s cost-benefit decision tree model and has arrived at the constraint conditions of social medical insurance fraud behavior and anti-fraud behavior. Under the guidance of theoretical analysis, By investigating on the spot and issuing questionnaires to get data. Combines with structural equation model to make an empirical study of social medical insurance fraud, we get fraud behavior’s cost and benefit’s weight on fraud behavior, this is for us to develop the social medical insurance fraud prevention measures to lay a solid foundation.From the aspect of cost-benefit theory, the last part of this paper gives a series of anti-fraud measures such as reducing fraud behavior’s benefit, improving fraud behavior’s cost, reducing anti-fraud behavior’s cost, and improving anti-fraud behavior’s benefit. By this paper, I am looking forward to add something to the prevention of China’s social medical insurance fraud behavior’s.