健康保险欺诈类型与防范对策

保险是现代社会的稳定器和减震器，是一种集王助性和科学性为一体的社会救济制度。这种制度是人们在社会实践中自发创造的，是依靠社会力量对付各种不可抗拒的自然灾害和意外事故损失的一种有效方式。然而一直伴随保险发展的阴影——保险欺诈，已演变成威胁世界保险业的头号公害。目前我国保险欺诈现象日益增多。特别是健康保险逆选择和道德风险都较为严重，欺诈骗赔的问题已越来越突出，给保险业和社会稳定带来了一定的负面影响。文章对健康保险欺诈的概念及特征、主要类型进行了分析。同时提出了防范健康保险欺诈的对策.     

保险欺诈的成因及对策

随着保险业的发展,保险欺诈案件亦呈现上升的趋势,保险欺诈扰乱了正常的保险经营活动,严重侵害了保险人和广大保户的合法权益,阻碍了中国保险业的健康发展。因此,研究保险欺诈及其法律对策,对准确地识别保险欺诈行为,增强防范,预防保险欺诈行为的发生,维护正常的保险秩序有着重要的意义。从投保人和保险人两个角度对保险欺诈的表现形式进行归纳,进而从经济原因、社会原因、保险公司内部原因三个层面对保险欺诈的成因进行探讨,并从信息不对称问题等六个方面对反保险欺诈的对策提出了防范建议。     

企业财产保险存在欺诈的原因及应对策略

随着我国保险事业的快速发展,企业财产保险欺诈手段越来越隐蔽,保险欺诈严重干扰了保险行业的正常经营,侵害了保险人和投保人的合法利益,防碍了我国保险业的健康发展。因此,研究企业财产保险存在欺诈的原因及应对策略,对准确识别企业财产保险的欺诈风险有着重要的意义,从而建立反欺诈体系,促进企业财产保险健康发展。     

关于保险欺诈的研究综述

保险欺诈问题已引起各国的高度重视，国内外不少学者对此作了研究，就此对国内外保险欺诈的研究现状进行分析，主要从保险欺诈研究的特点、角度、现状等方面总结比较，在此基础上探讨目前研究中存在的不足及未来的研究趋势。     

复保险欺诈法律规制

笔者认为复保险欺诈区别于善意复保险之处在于投保人于保险合同订立之际,意图谋取不当得利,或在保险合同有效期内知悉复保险的存在而不为通知,或故意为虚假通知.对于复保险欺诈的法律规制,认为应将复保险欺诈作为保险合同法定无效的原因,对严重的复保险欺诈应追究刑事责任;可以赋予保险人司法协助请求权,建立反保险欺诈信息中心.     

关于建立我国保险业欺诈检测系统的思考

由于信息不对称,保险人面临着严重的保险欺诈问题。为此,保险人必须对赔案进行分类和审计,但需要承受额外的成本并降低了服务水准。本文通过阐明保险欺诈检测系统对保险人的意义,对建立我国保险业欺诈检测系统进行了相关探讨。     

消费者对保险欺诈的态度研究

研究了影响消费者对保险欺诈态度的因素。回顾了国外相关研究并结合国内保险市场设计了调查问卷。研究结论显示,国外研究结论中主要影响因子,如对保险公司的认知、保险消费因素,环境因素等在本研究中没有显著统计学意义。本研究中消费者的道德、收入和对控制欺诈的态度成为主要影响因子。     

民国时期保险欺诈的盛行与惩治——以《申报》和《太安丰保险界》的记载为主要资料

保险欺诈的盛行是民国时期一项颇为引人注目的时弊。其欺诈手法因险种的不同而各具特点,保险欺诈对保险业的正常发展、民众生命财产的安全和社会风气的健全产生了严重危害。民国时期保险欺诈的频发既有保险行业自身的特殊性,又与社会经济的不景气、道德水准的低下和现代观念的缺失等有着更为直接的因果联系。为了惩处和防治保险欺诈,保险界、司法界及政府等有关方面作了多种努力,积累了一定的经验,但终究力度不够,成效有限,给后人留下了需要进一步思考和解决的重要课题。     

中国社会保险欺诈情况剖析

对社会保险欺诈的分析着重从养老、医疗、工伤三个方面入手,并将三者的保险欺诈贯穿于保费征缴、费用支付和基金管理全过程。针对目前存在的社会保险欺诈行为,提出从法律、制度、信息技术三个层面着手的反欺诈策略。     

影响农业保险意愿因素的实证分析——以吉林省农安县为例

农业是高风险产业,而今农业保险业务的落后,暴露了我国在发展农村保险市场过程中存在的诸多问题,为了促进农村保险的健康发展解决三农问题,本文基于吉林省农安县12个乡镇的实地调查数据,运用Logistic模型对财政补贴对农业保险需求的影响进行分析,得出农户受教育程度,收入状况等因素对农业保险需求存在显著影响,提出应当通过提高农民收入、扩大宣传、加大政府政策支持力度等措施来提高农业保险的有效需求,促进农业保险的发展。     

中国社会医疗保险道德风险刍议

中国社会医疗保险是由国家立法实行的一种非盈利性社会事业,关系到人们的生活健康、人力资源的保护增值与社会经济的有序发展,其要义不言而喻。然而,由于现行的医疗保险体制运行中的种种缺陷而引致的医保欺诈现象愈演愈烈,不仅给国家财政带来巨大负担,还给整个社会带来严重的信用危机。因此,医保道德风险的防范与控制已经刻不容缓。     

Binary choice models for rare events data: a crop insurance fraud application

This study implements a recently proposed score test that could help guide insurance fraud researchers in deciding whether to use a logit or a probit model in predicting insurance fraud probabilities, especially when the occurrence of ones in the dependent variable is much less than zeros. The test is easily implemented in a crop insurance fraud context and seems to be a promising method that could be applicable to analysing and detecting potentially fraudulent claims in various lines of insurance.     

Insurance Taxation and Insurance Fraud

It is common practice in the United States to impose a sales tax on insurance premiums. Insurance benefits are not taxed, and it is typically argued that they should not be taxed because they compensate for a loss. In this paper I present a case where the taxation of insurance benefits is preferable to the taxation of premiums. When insurance fraud is present—in the form of ex post moral hazard—a tax on insurance premiums increases the number of fraudulent claims in the economy, whereas a tax on insurance benefits may reduce fraud. More importantly, however, policyholders are made better off with a benefit tax than with a premium tax.     

The fog of fraud – Mitigating fraud by strategic ambiguity

Most insurance companies publish few data on the occurrence and detection of insurance fraud. This stands in contrast to the previous literature on costly state verification, which has shown that it is optimal to commit to an auditing strategy. The credible announcement of thoroughly auditing claim reports is a powerful deterrent. Yet, we show that uncertainty about fraud detection can be an effective strategy to deter ambiguity-averse agents from reporting false insurance claims. If, in addition, the auditing costs of the insurers are heterogeneous, it can be optimal not to commit, because committing to a fraud-detection strategy eliminates the ambiguity about auditing. Thus, strategic ambiguity can be an equilibrium outcome in the market. Even competition does not force firms to provide the relevant information. This finding is also relevant in other auditing settings, like tax enforcement.     

提高审计独立性的新思路：财务报表保险制度

审计师的独立性受损是导政审计失败的一个重要根源。财务报表保险制度对消除审计人员和上市公司管理层的利益关联,恢复注册会计师真实的独立地位,遏制上市公司造假具有不可替代的作用。我国目前实施财务报表保险制度具有可行性。     

BANKING LICENCES, BAILOUTS AND REGULATOR ABILITY

I analyse a model in which it is socially optimal for banks to manage depositor funds but in which concerns about fraud discourage depositing and justify regulation. The regulator screens bankers and decides the level of charter value which they will receive as incentive to prevent fraud. She can also encourage deposits by insuring them. The optimal policy depends upon the regulator's screening ability: high ability regulators rely upon charter value and low ability regulators rely upon deposit insurance. I relate these findings to the regulation of transition economy banks, to operational risk management, and to banking competition policy.     

Economics in Institutional Perspective,Memorial Essays in Honor of K. William Kapp

In the past, the standard discussions of market failures in economics textbooks confined themselves to issues involving externalities, public goods, and common property (open access). Subsequent to George Akerlof’s famous article “The Market for ‘Lemons,’” discussions of the problems created by asymmetric information gradually became standard fare, but the issues raised by thinking of asymmetric information in economic matters extend far beyond the used car and health insurance markets that are normally used as the paradigm cases. In fact, consideration of the problems of information will inevitably lead to an examination of the problems of market manipulation and fraud, especially in light of the 2008 financial crisis. Akerlof has travelled this path himself as indicated by his recent book with Robert Shiller, Phishing for Phools (2015). Akerlof and Shiller provide a litany of examples of manipulation and deception in advertising and in many markets including financial markets. They also have a chapter on “The Resistance and its Heroes” that highlights some of the people and agencies that have worked to expose and reduce phishing, but this chapter is remarkably sparse. What this article attempts to do is to fill out some of this history by focusing on the work of American institutional economists from Veblen to Galbraith, who critically examined the issues of manipulation and deception in advertising, salesmanship, and finance. Some general considerations relating to the problem of fraud are also discussed.     

THE NEED TO REFORM THE FEDERAL DEPOSIT INSURANCE SYSTEM

The biggest financial disaster in modern history struck the savings and loan industry during the 1980s. This paper argues that the unifying cause of this debacle was the way in which the federal deposit insurance system is structured. The fundamental cause was not fraud and deregulation, as is commonly argued. The government not only permitted reportedly insolvent institutions to continue to operate, it permitted many such institutions to grow by offering relatively high rates on their deposits. Unfortunately, the Financial Institutions Reform, Recovery, and Enforcement Act (FIRREA) of 1989 may not prevent a similar situation from ever recurring. Therefore, one must understand exactly what happened, what the FIRREA does and does not do, and the proposals for reforming the entire structure of the federal deposit insurance system.     

Health insurance and labor market outcomes: Joint decision-making within households

Most Americans obtain access to health insurance through an employer. In this paper, we ask how the link between health insurance and employment affects labor market choices such as whether to work full-time. To understand the effect of the incentives embedded in the employer-based insurance system, we study the joint decision-making of husbands and wives that determines the household's access to health insurance. We estimate the effect on a wife's (husband's) labor market outcomes of husband's (wife's) health insurance, allowing the health insurance of both spouses to be endogenous. Obtaining unbiased estimates of such effects is complicated by the likelihood that positive assortative mating creates correlations between a couple's characteristics and the possibility that there are important unobservable household income effects. Our innovation is to measure these biases by examining a second fringe benefit, paid sick leave, in addition to health insurance. We find that, as predicted, spouse's insurance has statistically significant negative effects on being offered own employer insurance as well as on the probability of working full-time with health insurance.     

我国健康保险有效需求的实证分析

有效保险需求是在当前特定时期内,在一定保险价格、一定购买力条件下现实的保险需求,是保险公司真正面对的业务来源。本文使用最近几年健康保险保费收入、城镇居民可支配收入、城镇基本医疗保险基金总收入及居民医疗保健支出等数据,通过建立回归模型对健康保险有效需求进行分析。结果显示：居民购买力和医疗费用的增长对我国健康保险的有效需求有显著影响,社会保险并未对商业健康保险产生替代作用,相反与健康保险保费收入同向增长。