Harbin Medical University Reports Findings in Public Health (How do moral hazard behaviors lead to the waste of medical insurance funds? An empirical study from China): Health and Medicine – Public Health

2022 NOV 30 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- New research on Health and Medicine - Public Health is the subject of a report. According to news reporting out of Harbin, People’s Republic of China, by NewsRx editors, research stated, “The huge loss of health insurance funds has been a topic of concern around the world. This study aims to explore the network of moral hazard activities and the attribution mechanisms that lead to the loss of medical insurance funds.”

Our news journalists obtained a quote from the research from Harbin Medical University, “Data were derived from 314 typical cases of medical insurance moral hazards reported on Chinese government official websites. Social network analysis (SNA) was utilized to visualize the network structure of the moral hazard activities, and crisp-set qualitative comparative analysis (cs/QCA) was conducted to identify conditional configurations leading to funding loss in cases. In the moral hazard activity network of medical insurance funds, more than 50% of immoral behaviors mainly occur in medical service institutions. Designated private hospitals (degree centrality = 33, closeness centrality = 0.851) and primary medical institutions (degree centrality = 30, closeness centrality = 0.857) are the main offenders that lead to the core problem of medical insurance fraud (degree centrality = 50, eigenvector centrality = 1). Designated public hospitals (degree centrality = 27, closeness centrality = 0.865) are main contributor to another important problem that illegal medical charges (degree centrality = 26, closeness centrality = 0.593). Non-medical insurance items swap medical insurance items (degree centrality = 28), forged medical records (degree centrality = 25), false hospitalization (degree centrality = 24), and overtreatment (degree centrality = 23) are important immoral nodes. According to the results of cs/QCA, low-economic pressure, low informatization, insufficient policy intervention, and organization such as public medical institutions, were the high-risk conditional configuration of opportunism; and high-economic pressure, insufficient policy intervention, and organizations, such as public medical institutions and high violation rates, were the high-risk conditional configuration of risky adventurism (solution coverage = 31.03%, solution consistency = 90%). There are various types of moral hazard activities in medical insurance, which constitute a complex network of behaviors. Most moral hazard activities happen in medical institutions. Opportunism lack of regulatory technology and risky adventurism with economic pressure are two types causing high loss of funds, and the cases of high loss mainly occur before the government implemented intervention.”

According to the news editors, the research concluded: “The government should strengthen the regulatory intervention and improve the level of informatization for monitoring the moral hazard of medical insurance funds, especially in areas with low economic development and high incident rates, and focus on monitoring the behaviors of major medical services providers.”

For more information on this research see: How do moral hazard behaviors lead to the waste of medical insurance funds? An empirical study from China. Frontiers in Public Health, 2022;10:988492. Frontiers in Public Health can be contacted at: Frontiers Media Sa, Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland.

Our news journalists report that additional information may be obtained by contacting Jingjing Liu, Dept. of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, People’s Republic of China. Additional authors for this research include Yinghua Qin, Jiacheng Li, Rizhen Wang, Pengfei Guo, Huan Liu, Zheng Kang and Qunhong Wu.

Publisher contact information for the journal Frontiers in Public Health is: Frontiers Media Sa, Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland.

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