设计中国健康保险体系的风险平衡机制  

Design the Risk Equilibrium Mechanism of China's Health Insurance System

作　　者：王骜然 李皓月 石晓军[2,3] WANG Aoran;LI Haoyue;SHI Xiaojun

机构地区：[1]中国人民大学财政金融学院,中国财政金融政策研究中心 [2]中国人民大学财政金融学院 [3]中国人民大学中国财政金融政策研究中心

出　　处：《保险研究》2018年第6期16-23,共8页Insurance Studies

基　　金：本文的研究得到原中国保险监督管理委员会部级课题《全球主要市场商业医疗保险保障水平对比研究》、中国人民大学科学研究基金资助.

摘　　要：为抑制健康保险体系中的双向逆选择问题,主要发达国家纷纷筹备建立了风险平衡机制,通过后端的风险分散与平衡,使保险公司在社群定价的同时,实现保费与所承保健康风险的高度匹配。近年来,随着中国经济水平的提升和居民慢病化趋势的凸显,中国居民的健康保险需求持续上涨,然而,健康险市场内在的双向逆选择和产品结构错配问题却限制了健康险市场的广度与深度,使居民的健康保险需求难以得到充分满足。本文基于风险平衡机制的全球实践及对其福利提升作用的剖析,立足中国国情,对在中国设立风险平衡机制的必要性和可行路径做出了深入分析,为中国健康险市场的发展提供参考。Risk equilibrium mechanism plays a vital role in hedging the systematic risks in the health insurance markets of developed countries. Through risk spread and balancing at the back end, insurance companies can achieve high level matching of premiums and health risks at community pricing. In recent years, along with China＇ s economic growth, chronic diseases have become a prominent issue, therefore demands for health insurance are on the rise constantly. However, the inherent two-way adverse selection and product mix mismatching have constrained the breadth and depth of the health insurance market, falling behind the demands for health insurance coverage. This paper analyzed the prominent patterns of risk equilibrium in the world and its enhancement on people＇ s well-being. Then taking into consideration of China＇ s specific situations, the paper made an in-depth exploration on the necessi- ty of and feasible path for establishing the risk equilibrium mechanism in China. Hopefully it may be of some use for the development of health insurance market in China.

关 键 词：健康保险 风险平衡机制 信息不对称 双向逆选择 

分 类 号：F841[经济管理—保险]