基本医保约束下惠民保运行机理、发展趋势与政策建议  

The Operation Mechanism,Development Trend and Policy Suggestions of City Customized Commercial Medical Insurance(CCCMI)under the Constraints of Basic Medical Insurance

作　　者：马振涛 臧春静[3] Ma Zhentao;Zang Chunjing

机构地区：[1]安阳师范学院马克思主义学院,河南安阳455000 [2]北京师范大学政府管理研究院,北京100875 [3]北京环境卫生工程集团有限公司,北京100101

出　　处：《西南金融》2022年第12期56-68,共13页Southwest Finance

基　　金：国家社科基金一般项目“数字技术赋能城市群协同治理问题研究”(批准号:22BGL269);河南省软科学研究项目“三螺旋模式、政策实验与中国科技创新治理研究”(批准号:212400410073)。

摘　　要：基本医保约束条件下,惠民保作为连接基本医疗保险与商业医疗保险之间的“纽带”备受重视并得以广泛推广。本文在分析惠民保内涵形态与基本属性,并探究其产生背景和运行机理的基础上,研判惠民保能否发展成“第二医保”趋势及如何避免陷入“死亡螺旋”问题,并提出以下政策建议:做好顶层设计,提升社会认知度和覆盖面;完善商业模式,搭建基于惠民保平台的健康服务生态;强化政企合作,提升服务针对性和有效性;规范运行机制,确保惠民保长期惠民利民。Under the constraints of basic medical insurance,CCCMI as a"link"between basic medical insurance and commercial medical insurance,has been paid much attention to and has been widely promoted.On the basis of analyzing the connotation and basic attributes of CCCMI,and exploring its background and operation mechanism,this article examines whether CCCMI can develop into a"second medical insurance"and how to avoid falling into a"death spiral",and makes the following policy recommendations:to improve the top-level design to enhance social awareness and coverage;to improve the business model to build a health service ecology based on the CCCMI platform;to strengthen the cooperation between government and enterprises to enhance the targeting and effectiveness of services;and to standardize the operation mechanism to ensure that CCCMI benefits the people in the long run.

关 键 词：惠民保 普惠保险 基本医保 商业医疗保险 补充医疗保险 医疗保障 社会保障 健康中国 

分 类 号：F832.39[经济管理—金融学] F840.67