完善上海市基本医疗保险体系研究：基于商业健康保险视角  

Study on improving the basic health insurance system in Shanghai: Based on the perspective of commercial health insurance

作　　者：陈珉惺[1] 王力男[1,2] 杨燕[1] 王贤吉[1] 金春林[1,3] 

机构地区：[1]上海市卫生发展研究中心上海市医学科学技术情报研究所,上海200040 [2]上海财经大学公共经济管理学院,上海200433 [3]上海市人口与发展研究中心,上海201199

出　　处：《中国卫生政策研究》2015年第11期52-56,共5页Chinese Journal of Health Policy

基　　金：2014年度上海市医疗保险协会委托课题;美国中华医学基金会卫生体系研究与政策转化合作项目(CMB-CP14-190);上海市公共卫生重点学科建设计划-卫生经济学(12GWZX0601)

摘　　要：上海市基本医疗保险虽在覆盖面、筹资水平、保障水平等方面处于国内领先地位,但仍无法避免就医需求快速上升和基金管理效果不佳等问题带来的矛盾。商业健康保险在资金和人员管理方面有其独特的优势,可发挥其对基本医疗保险的补充作用,完善基本医疗保险体系。本文基于商业健康保险的视角,从经办模式、经办主体、保障对象、筹资方式和保障项目5个方面对上海市基本医疗保险体系进行探索和完善。Although the Shanghai＇s basic health insurance always takes the leading position nationwide in the aspects of coverage,funding level,security level,etc,it still cannot avoid the contradictory problems brought by the rapidly rising demand for health care,poor results of funds management,etc. Commercial health insurance has its unique advantages in terms of funds and personnel management. Therefore,they can play their complementary role to the basic medical insurance in order to improve the basic health insurance system. Based on the perspective of commercial health insurances,this paper explores the basic health insurance system in Shanghai from the aspects of management patterns,governing body,insurance objects,funding modalities and insurance programs.

关 键 词：基本医疗保险 商业健康保险 上海市 

分 类 号：R197[医药卫生—卫生事业管理]