An Analysis on the Social Health Insurance Fraud under Different Payment Modes

Due to the intricacy of social health insurance and specialty of medical service,it is hard to supervise health insurance fraud.To constrain and encourage certain behaviors of both the doctors and the patients by adopting different payment modes will serve as an effective way to protect the security of the health insurance fund.To prevent the patients' fraud,the Block Model is better than the Channel Model in terms of management,while in the prevention of fraud of hospital staff a combination of different payment modes should be adopted.Furthermore,the risk prevention and cost control should not be at the cost of service quality.