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    Please use this identifier to cite or link to this item: http://tkuir.lib.tku.edu.tw:8080/dspace/handle/987654321/32443

    Title: 醫療保險詐欺之研究
    Other Titles: Claim of health insurance
    Authors: 黃俊豪;Huang, Chuang-hao
    Contributors: 淡江大學保險學系保險經營碩士班
    胡宜仁;Hu, Yi-jen
    Keywords: 帳戶式醫療保險;逆選擇;Accelerated hospitalization benefits;Anti-selection
    Date: 2005
    Issue Date: 2010-01-11 02:09:24 (UTC+8)
    Abstract: 醫療保險目的是在填補被保險人因意外或疾病住院時,藉由商業保險的保險金給付,得到基本社會保險保障以外無法支付的費用,然而,近幾年來由於經濟不景氣,醫療保險卻成為犯罪詐欺工具之一,實有必要針對現行醫療保險詐欺防制論述。
    一 、醫療體系面臨之問題
    The purpose of health insurance claim is to indemnify loss from hospitalizing because of accident or illness and get compensation when the hospitalization expense may beyond social insurance claim. However, health insurance has become a tool of fraud crime due to the economic depression recently, so that this study is aimed to expound a prevention system on health insurance fraud.
    In this study, we mainly focus on an actual insurance fraud case to present its seriousness and problems for giving contributions to develop a wholesome health insurance prevention system. The contents are:
    1.Medical System Problems
    Anamnesis versus health insurance fraud
    National health insurance declaration
    The controversy of fraudulent and excessive hospitalization
    Inferior quality hospital and clinic
    2.Problems of insured and criminal group
    3.Insurance company management analysis
    4.Supervise system analysis
    5.Judiciary verdict analysis
    The various components of health insurance fraud prevention system need highly professional proficiency. Only when those components modify their own problems by themselves, the whole system should be facilitated to decrease health insurance fraud and then to promote the insured’s medical quality.
    Appears in Collections:[保險學系暨研究所] 學位論文

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