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中国主流互助保险平台风险评价

来源: 南方日报网络版     时间: 2018年10月23日 21:56:31
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(原)(标)(题)(:中)(国)(主)(流)(互)(助)(保)(险)(平)(台)(风)(险)(评)(价)(
相)(互)(保)(险)(在)(国)(外)(占)(据)(保)(险)(市)(场)(进)(30%份)(额)(,源)(于)(社)(会)(信)(任)(和)(一)(些)(体)(制)(的)(原)(因)(,国)(内)(相)(互)(保)(险)(市)(场)(几)(乎)(空)(白)(。国)(内)(近)(两)(年)(兴)(起)(的)(互)(助)(保)(险)(,被)(广)(泛)(寄)(希)(望)(于)(能)(借)(助)(互)(联)(网)(实)(现)(相)(互)(保)(险)(这)(一)(市)(场)(功)(能)(,降)(低)(保)(费)(水)(平)(,惠)(及)(民)(众)(。然)(而)(目)(前)(国)(内)(主)(流)(互)(助)(保)(险)(平)(台)(在)(机)(制)(设)(计)(上)(存)(在)(缺)(陷)(,部)(分)(环)(节)(存)(在)(人)(为)(操)(作)(空)(间)(,限)(制)(着)(互)(助)(保)(险)(的)(快)(速)(发)(展)(。
本)(文)(从)(制)(度)(设)(计)(的)(角)(度)(,客)(观)(分)(析)(现)(行)(主)(流)(平)(台)(的)(一)(些)(制)(度)(设)(计)(的)(缺)(陷)(,及)(其)(可)(能)(产)(生)(的)(人)(为)(操)(作)(空)(间)(。
一)(、互)(助)(保)(险)(平)(台)(参)(与)(
缺)(陷)(1:平)(台)(篡)(改)(投)(保)(人)(数)(
如)(果)(平)(台)(将)(投)(保)(人)(数)(虚)(报)(为)(实)(际)(人)(数)(的)(一)(半)(,则)(针)(对)(每)(笔)(赔)(付)(,每)(位)(投)(保)(人)(需)(均)(摊)(两)(倍)(!平)(台)(轻)(易)(获)(利)(其)(中)(一)(半)(。(如)(实)(际)(200万)(人)(参)(保)(,被)(虚)(报)(成)(100万)(人)(,针)(对)(一)(笔)(30万)(元)(的)(赔)(付)(,平)(台)(按)(100万)(人)(计)(算)(,实)(际)(向)(200万)(人)(的)(账)(户)(每)(人)(扣)(款)(0.3元)(,累)(计)(扣)(款)(60万)(。)
解)(决)(方)(案)(:在)(交)(易)(底)(层)(采)(用)(区)(块)(链)(技)(术)(,能)(较)(好)(的)(保)(证)(公)(开)(性)(、公)(正)(性)(和)(不)(可)(篡)(改)(性)(。
缺)(陷)(2:平)(台)(篡)(改)(投)(保)(时)(间)(、投)(保)(人)(身)(份)(
假)(设)(某)(患)(者)(在)(观)(察)(期)(180天)(内)(患)(病)((甚)(至)(在)(确)(诊)(之)(后)(才)(投)(保)(),理)(应)(不)(受)(保)(单)(保)(护)(,如)(果)(此)(时)(平)(台)(篡)(改)(其)(投)(保)(起)(始)(日)(期)(至)(180天)(前)((甚)(至)(将)(某)(有)(效)(投)(保)(人)(身)(份)(篡)(改)(为)(该)(患)(者)(),则)(能)(使)(其)(成)(为)(保)(单)(保)(护)(对)(象)(,而)(违)(规)(输)(送)(利)(益)(。
解)(决)(方)(案)(:在)(交)(易)(底)(层)(采)(用)(区)(块)(链)(技)(术)(,能)(较)(好)(的)(保)(证)(公)(开)(性)(、公)(正)(性)(和)(不)(可)(篡)(改)(性)(。
缺)(陷)(3:虚)(构)(患)(者)(,与)(鉴)(定)(机)(构)(、医)(院)(合)(谋)(欺)(诈)(
如)(果)(平)(台)(与)(鉴)(定)(机)(构)(、医)(院)(协)(商)(,直)(接)(虚)(构)(一)(批)(患)(者)(和)(病)(历)(,并)(由)(鉴)(定)(和)(机)(构)(、医)(院)(签)(字)(通)(过)(,由)(平)(台)(向)(每)(位)(投)(保)(人)(账)(户)(扣)(款)(,则)(可)(大)(批)(量)(、持)(续)(性)(获)(利)(。
解)(决)(方)(案)(:在)(交)(易)(底)(层)(采)(用)(区)(块)(链)(技)(术)(,同)(时)(,采)(用)(公)(众)(监)(督)(制)(度)((见)(下)(文)()能)(降)(低)(合)(谋)(行)(为)(的)(严)(重)(程)(度)(。
缺)(陷)(4:平)(台)(挪)(用)(保)(险)(资)(金)(
在)(投)(资)(收)(益)(或)(经)(营)(压)(力)(的)(驱)(使)(下)(,如)(果)(平)(台)(挪)(用)(保)(险)(资)(金)(,将)(会)(对)(每)(位)(投)(保)(人)(带)(来)(风)(险)(。
解)(决)(方)(案)(:保)(险)(资)(金)(采)(用)(银)(行)(托)(管)(。(当)(资)(金)(量)(大)(到)(银)(行)(与)(平)(台)(的)(心)(理)(诱)(惑)(临)(界)(点)(附)(近)(时)(,两)(者)(会)(否)(合)(谋)(违)(规)(操)(作)(依)(旧)(存)(在)(不)(确)(定)(性)(。)
二)(、互)(助)(保)(险)(平)(台)(不)(参)(与)(
医)(院)(与)(患)(者)(合)(谋)(欺)(骗)(,医)(院)(与)(鉴)(定)(机)(构)(与)(患)(者)(合)(谋)(欺)(骗)(,等)(等)(是)(保)(险)(业)(面)(临)(的)(共)(同)(难)(题)(,但)(互)(助)(保)(险)(这)(一)(问)(题)(显)(得)(尤)(为)(严)(重)(,笔)(者)(此)(处)(提)(出)(“公)(众)(监)(督)(制)(度)(”试)(图)(能)(一)(定)(程)(度)(上)(解)(决)(这)(一)(难)(题)(。
公)(众)(监)(督)(制)(度)(:每)(例)(病)(情)(,由)(平)(台)(随)(机)(抽)(取)(3名)(用)(户)(作)(为)(监)(督)(者)(,监)(督)(者)(可)(将)(监)(督)(资)(格)(挂)(牌)(转)(让)(,不)(够)(信)(任)(平)(台)(的)(用)(户)(,可)(购)(买)(监)(督)(资)(格)(,参)(与)(该)(例)(病)(情)(的)(医)(疗)(机)(构)(操)(作)(流)(程)(、鉴)(定)(机)(构)(操)(作)(流)(程)(的)(全)(程)(监)(督)(。同)(时)(,为)(防)(止)(竞)(争)(对)(手)(大)(量)(购)(买)(监)(督)(资)(格)(可)(以)(散)(布)(抹)(黑)(言)(论)(,需)(对)(监)(督)(者)(作)(以)(下)(限)(定)(:其)(言)(论)(仅)(能)(出)(现)(在)(鉴)(定)(报)(告)(中)((可)(以)(是)(负)(面)(意)(见)(,或)(正)(面)(意)(见)()且)(每)(一)(条)(不)(同)(意)(见)(均)(有)(医)(院)(、鉴)(定)(机)(构)(的)(正)(式)(答)(复)(;仅)(能)(对)(医)(疗)(过)(程)(某)(具)(体)(环)(节)(提)(出)(具)(体)(的)(意)(见)((而)(不)(能)(泛)(泛)(而)(谈)(进)(行)(抹)(黑)();仅)(支)(持)(其)(本)(人)(参)(与)(,且)(一)(年)(不)(超)(过)(两)(次)(。
随)(着)(监)(督)(、评)(价)(逐)(渐)(增)(多)(,一)(般)(会)(逐)(渐)(得)(到)(关)(于)(本)(平)(台)(产)(品)(的)(合)(理)(的)(舆)(论)(评)(价)(。同)(时)(,监)(督)(者)(的)(公)(开)(而)(又)(具)(体)(的)(言)(论)(,一)(般)(会)(促)(进)(平)(台)(更)(快)(迭)(代)(产)(品)(,促)(进)(鉴)(定)(机)(构)(、医)(院)(与)(患)(者)(更)(合)(规)(的)(操)(作)(,以)(及)(赔)(付)(流)(程)(的)(更)(高)(效)(透)(明)(能)(获)(得)(更)(好)(更)(广)(泛)(的)(信)(任)(。在)(人)(道)(主)(义)(或)(其)(他)(人)(文)(关)(怀)(方)(面)(,监)(督)(者)(与)(鉴)(定)(机)(构)(带)(来)(的)(问)(题)(是)(一)(样)(的)(。
缺)(陷)(5:患)(者)(与)(医)(院)(合)(谋)(,虚)(夸)(病)(情)(,伪)(造)(用)(药)(或)(医)(疗)(服)(务)(
患)(者)(在)(认)(定)(病)(情)(时)(,时)(常)(根)(据)(具)(体)(病)(症)(来)(具)(体)(处)(理)(,如)(果)(此)(时)(医)(院)(虚)(夸)(该)(病)(人)(病)(情)(,并)(伪)(造)(用)(药)(或)(医)(疗)(服)(务)(以)(获)(取)(更)(高)(赔)(付)(,在)(鉴)(定)(机)(构)(的)(识)(别)(能)(力)(存)(在)(不)(同)(程)(度)(受)(限)(的)(真)(实)(世)(界)(中)(,较)(有)(可)(能)(通)(过)(鉴)(定)(。
解)(决)(方)(案)(:多)(篇)(研)(究)(报)(告)(指)(出)(,定)(点)(医)(院)(制)(度)(下)(定)(点)(医)(院)(由)(于)(长)(期)(合)(作)(的)(利)(益)(驱)(动)(,其)(违)(规)(行)(为)(一)(般)(会)(显)(著)(下)(降)(。同)(时)(,采)(用)(公)(众)(监)(督)(制)(度)(能)(显)(著)(降)(低)(合)(谋)(行)(为)(的)(严)(重)(程)(度)(。
缺)(陷)(6:患)(者)(与)(鉴)(定)(机)(构)(合)(谋)(,超)(标)(准)(用)(药)(或)(医)(疗)(服)(务)(
患)(者)(针)(对)(保)(险)(条)(款)(中)(规)(定)(,超)(标)(准)(用)(药)(和)(医)(疗)(服)(务)(,如)(果)(此)(时)(鉴)(定)(机)(构)(与)(患)(者)(合)(谋)(,由)(鉴)(定)(机)(构)(签)(字)(通)(过)(以)(获)(得)(患)(者)(某)(种)(形)(式)(的)(报)(酬)(,则)(容)(易)(导)(致)(不)(合)(理)(赔)(付)(。
解)(决)(方)(案)(:同)(定)(点)(医)(院)(制)(度)(,如)(果)(选)(定)(少)(数)(第)(三)(方)(鉴)(定)(机)(构)(合)(作)(,由)(于)(长)(期)(合)(作)(的)(利)(益)(驱)(动)(,其)(违)(规)(行)(为)(一)(般)(会)(显)(著)(下)(降)(。同)(时)(,采)(用)(公)(众)(监)(督)(制)(度)(能)(显)(著)(降)(低)(合)(谋)(行)(为)(的)(严)(重)(程)(度)(。
缺)(陷)(7:鉴)(定)(机)(构)(与)(医)(院)(合)(谋)(
某)(患)(者)(的)(保)(单)(赔)(付)(额)(度)(足)(以)(覆)(盖)(其)(医)(疗)(费)(用)(时)(,其)(一)(般)(不)(太)(关)(心)(医)(疗)(费)(用)(水)(平)(,如)(果)(此)(时)(医)(院)(与)(鉴)(定)(机)(构)(合)(谋)(,大)(幅)(标)(高)(某)(些)(医)(药)(或)(医)(疗)(服)(务)(价)(格)(水)(平)(,则)(容)(易)(导)(致)(利)(益)(输)(送)(。
解)(决)(方)(案)(:采)(用)(公)(众)(监)(督)(制)(度)(能)(显)(著)(降)(低)(合)(谋)(行)(为)(的)(严)(重)(程)(度)(。同)(时)(可)(采)(用)(定)(点)(机)(构)(合)(作)(制)(度)(。
三)(、中)(国)(主)(流)(互)(助)(保)(险)(平)(台)(风)(险)(评)(价)(
需)(要)(特)(别)(说)(明)(的)(是)(,操)(作)(空)(间)(的)(客)(观)(存)(在)(是)(事)(实)(,但)(运)(营)(者)(会)(否)(利)(用)(操)(作)(空)(间)(来)(获)(利)(甚)(至)(欺)(诈)(,是)(另)(一)(回)(事)(。客)(观)(上)(,创)(始)(人)(的)(背)(景)(与)(平)(台)(会)(否)(违)(规)(操)(作)(存)(在)(一)(定)(相)(关)(性)(,故)(此)(处)(在)(评)(价)(互)(助)(保)(险)(平)(台)(的)(风)(险)(时)(特)(加)(上)(创)(始)(人)(背)(景)(一)(项)(。
注)(:评)(分)(A表)(示)(该)(项)(下)(尚)(存)(一)(定)(操)(作)(空)(间)(,评)(分)(A+表)(示)(已)(得)(到)(较)(好)(解)(决)(。
作)(者)(:|来)(源)(:未)(央)(网)(
原)(文)(阅)(读)(请)(点)(击)(
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∞未)(央)(网)(由)(清)(华)(大)(学)(五)(道)(口)(金)(融)(学)(院)(互)(联)(网)(金)(融)(实)(验)(室)(创)(办)(
∞订)(阅)(微)(信)(号)(:iefinance致)(力)(于)(互)(联)(网)(金)(融)(知)(识)(研)(究)(与)(分)(享)(返)(回)(搜)(狐)(,查)(看)(更)(多)(责)(任)(编)(辑)(:
声)(明)(:该)(文)(观)(点)(仅)(代)(表)(作)(者)(本)(人)(,搜)(狐)(号)(系)(信)(息)(发)(布)(平)(台)(,搜)(狐)(仅)(提)(供)(信)(息)(存)(储)(空)(间)(服)(务)(。
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