| Summary: | 碩士 === 淡江大學 === 保險學系保險經營碩士在職專班 === 99 === According to Paul, center statistics health insurance premiums from 84 years when the NHI was 45.1 billion yuan, jumped to 97 years of 1,973.3 billion yuan, nearly 14 years, premium growth of 44 times, thus opening up more to arouse the national health insurance mass health insurance increased demand. National health expenditures (NHE) by per capita income continued to increase, the relative importance of national quality of life improved; and the gradual aging of the population structure and the impact of advances in medical technology, resulting in health care spending has been rising. Open for national health insurance, some of people have medical insurance, use of medical resources, misuse of resources, or some improper business in order to survive and medical institutions and patients diagnosed with conspiracy to create false profits.
Recommended that the competent authorities shall assist the insurance companies to establish liaison mechanisms with the Health Insurance Bureau, on a regular basis with the insurance company for two-way exchange of information and communication, medical institutions and the establishment of non-performing list misuse of medical resources, databases and so on.
Insurance companies and policyholders is indeed controversial issue of medical professional conduct, the health insurance product design, underwriting, claims etc are more complex and time-consuming, mainly because of moral hazard and health risk factors, adverse selection is more difficult to distinguish but the ratio also higher. In this paper, chi-square, to evidence the insurance claim check when the level of medical expenditures, and the hospital''s medical relationship.
Policyholders of insurance companies for risk management: the case through a specific service, will reduce the risk of morbidity or complications, and reduce health care expenditures and lower insurance claims and lower insurance made a complaint or appeal of the cost of the insurance bureau.
The medical institutions of the physician if a patient has abnormal status treatment, should the physician consultation other divisions, so that patients receive appropriate counseling, in order to avoid unnecessary medical expenses and increasing social costs, so that Taiwan''s health care system can more robust. Based on the above analysis, so the private medical hospital] [profit-oriented purposes. Therefore, in the course of treatment, have more motivation and needs, so that inpatient and outpatient and surgical hospitals pay higher than public spending. That insurance companies in the insurance policy number and amount of all claims presented to this phenomenon
But also through the study of theory and literature, to jointly seek the insurance industry in the future how to deal with insurance claims of appropriate practices. Amending the law department as to provide future goods or review the terms of reference.
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