我国补充医疗保险职能再界定与政策优化  

Functions of China's Supplementary Medical Insurances Redefinition and Support Policies Optimization

作　　者：李亚军[1] 吴孝芹[1] 

机构地区：[1]山东工商学院公共管理学院,山东烟台264005

出　　处：《山东工商学院学报》2018年第1期112-124,共13页Journal of Shandong Technology and Business University

基　　金：教育部社科基地重大研究项目"社会保障管理体制研究"(13JJD63010)

摘　　要：在基本医疗保险基础上,发展多层次补充医疗保险满足社会分担医疗费用、分散大病风险和提供个性化选择需求是医疗保障事业发展的趋势之一。明确基本与补充医疗保险以及不同层次补充医疗保险的主要职能及其边界是保险公司专业化运作的基础,也是政府提供差别化优惠政策的前提。本文分析了各项补充医疗保险发展现状、问题及其原因,提出清晰界定医疗保险各个层次界限和职能、提升补充保险经营主体业务自主性、构建中小企业和个人参保一站式服务平台、优化税收优惠政策并引入补贴政策以及建设社保、商保和医疗服务机构信息共享平台等政策建议。After a close to complete coverage of basic medical insurance,develop multi-level supplementary medical insurance for medical expenses,risks of a critical illness,and individual choice to safeguard health care is one of the trend of the medical security system. Clearly define main function and boundary between basic and supplementary medical insurance as well as different levels of supplementary medical insurance is not only the basis of the insurance company specialized operations but also the premise of government provide differentiated preferential policies. This paper analyzes the development situations,problems and their reasons of various supplementary medical insurance put forward the following suggestions. Redefine function and boundary of multi-level medical insurances; enhance autonomy of insurance company in operating supplementary medical insurance; establish one-stop service platform for small and medium-sized enterprises and individuals to participate in insurance; optimize the tax preferential policies and introduce the subsidy policy; construct unified information sharing platform for social insurance and commercial insurance and health-care institutions.

关 键 词：补充医疗保险 商业健康保险 医保改革 

分 类 号：F842.625[经济管理—保险]