| 新型农村合作医疗保险欺诈风险度量实证研究 |
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| 引用本文： | 李连友,林源.新型农村合作医疗保险欺诈风险度量实证研究[J].中国软科学,2011(9). |
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| 作者姓名： | 李连友 林源 |
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| 作者单位： | 湖南大学金融与统计学院,湖南长沙,410082 |
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| 基金项目： | 教育部新世纪人才支持计划，湖南省哲学社会科学成果评审课题支助项目《新型农村合作医疗保险欺诈风险管理研究》 |
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| 摘 要： | 本文根据损失分布法的基本原理,采用聚合风险模型度量新农合医疗保险的欺诈风险,并运用蒙特卡洛模拟对新农合欺诈风险的经验数据进行了实证分析.研究表明,社会专门欺诈团伙、定点医疗机构和参合农民是三大主要欺诈主体,其中社会专门欺诈团伙和定点医院的欺诈对新农合基金造成的损失最大(占94％)；欺诈风险损失频率服从正态分布,其损失强度(损失金额对数值)服从weibull分布,在99％的置信水平下,我国每年需计提约2897万元的欺诈风险准备金.
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| 关 键 词： | 新农合 欺诈风险 度量 蒙特卡洛模拟 |
Empirical Study on Measuring the Fraud Risk in the New Rural Cooperative Medical Insurance |
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| LI Lian-you,LIN Yuan.Empirical Study on Measuring the Fraud Risk in the New Rural Cooperative Medical Insurance[J].China Soft Science,2011(9). |
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| Authors: | LI Lian-you LIN Yuan |
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| Institution: | LI Lian-you,LIN Yuan(School of Finance and Statistics,Hunan University,Changsha 410082,China) |
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| Abstract: | According to the principle of Loss Distribution Method,this paper measures the fraud risk of the New Rural Cooperative Medical Insurance by means of the collective risk model,and makes an empirical study using Monte Carlo Model.The result shows,the social specialized fraud groups,the designated medical institutions and the insured are the three main fraud perpetrators,and the fund losses of fraud caused by the first two is 94%;the loss frequency fits normal distribution and the loss strength fits the Weibul... |
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| Keywords: | New Rural Cooperative Medical Insurance fraud risk measuring Monte Carlo simulation |
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