商业健康保险与社会医疗保险制度对接路径设计——基于再保险与共同保险的视角  

The Reinsurance and Coinsurance Design of Cooperation Mechanism between Social Health Insurance and Private Health Insurance

作　　者：张颖[1] 胡炳志[2] 许佳馨 

机构地区：[1]东南大学经济管理学院 [2]武汉大学社会保障研究中心

出　　处：《经济体制改革》2015年第3期160-164,共5页Reform of Economic System

基　　金：国家自然科学基金项目"资产价格波动与实体经济:影响机制及其动态均衡研究"(71473036);教育部人文社会科学研究青年项目"我国城乡居民大病保险:筹资机制;模型构建及其可持续性研究"(14YJC630202);高校哲学社会科学基金与东南大学科研基础扶持经费共同资助项目"基于区域差异的江苏省大病保险筹资模型构建及其应用研究"(2014SJD013;2242014S20069)

摘　　要：商业健康保险与社会医疗保险制度的有效对接,既可降低因商业健康保险人与病患间信息不对称所致的额外成本,又可在多个参与者(个人、雇主、保险人)追求自身利益最大化的同时,达成"将个人自付水平控制在医疗费用总支出的30%以内"的既定目标。路径设计主要依照险位超赔再保险技术,具体内容为:社会医疗保险管理机构以重特大疾病医疗保险等形式与商业健康保险人签订分保合同,转嫁部分风险,商业健康保险人作为再保险人,获得商业利益的同时,分摊社会损失,满足居民的多层次保障需求。实践中,还可视情况将再保险与共同保险结合运用,使风险分散更为彻底。The interactive mechanism between social and private health insurance and its sustainable performance could significandy alleviate the cost of additional information due to asymmetric information between patients and insurers, and also to improve the coverage and level of China＇s urban and rural residents＇ medical protection while the participants （ including the indi- vidual, the employer and the insurer） are pursuing self - interest maximization and achieving the primary goals of ＂limiting out - of - pocket expenditure as a ratio of total medical spending less than 30% ＂. Based on reinsurance approach, management agen- cies of social health insurance sign contracts with commercial health insurers in the form of critical illness insurance for boring proportions of the risk. Commercial health insurers as reinsurers, gain the profits and meet diversified health care needs of resi- dents. In practice, the reinsurance and the coinsurance approaches could work together to diversify risks more thorough.

关 键 词：社会医疗保险制度 商业健康保险 对接路径设计 险位超赔再保险 

分 类 号：F843[经济管理—保险]