关键词: 健康保险, 风险控制, 三方博弈

Abstract: In recent years, commercial health insurance has received extensive social attention. Although commercial health insurance is beneficial to the state and citizens, current situation of high compensation is a problem that haunts big insurance companies, so risk control becomes the core in companies’ operation. Different from most qualitative studies at home and abroad, this paper, applying the theory of gaming from a perspective of quantity, construct a risk control gaming model so as to reveal the rules of the risk control of commercial health insurance at a deep level. The gaming model and balanced results show that insurance companies in the core positions of the entire business process shall enhance their ability of risk control by promoting their professional operating level, strengthening the control of supervision cost, and scientifically establishing the mechanism of credit rewarding and crack credit punishment. Meanwhile, they also shall change the supervision pattern of medical care providers and the assured, shifting from the supervision after event to the supervision before and in the mid of event.