美国Medicare社商合作模式对我国"惠民保"发展的启示  

Enlightenment of the cooperative mode between social and commercial of Medicare in the United States on development of " City-customized Medical Insurance" in China

作　　者：郑洋洋 杨萌 符明龙 江世英 廉凯 Zheng Yangyang;Yang Meng;Fu Minglong;Jiang Shiying;Lian Kai(Medical Insurance Office,Xiangyang No.1 People′s Hospital,Hubei University of Medicine,Xiangyang 441000,China;School of Public Health,Hubei University of Medicine,Shiyan 442000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院医保办,襄阳441000 [2]湖北医药学院公共卫生与健康学院,十堰442000

出　　处：《中华医院管理杂志》2022年第12期896-900,共5页Chinese Journal of Hospital Administration

基　　金："十四五"湖北省高等学校优势特色学科群(公共卫生与健康)项目资助(2022PHXKQ4)。

摘　　要："惠民保"作为我国推进多层次医疗保障体系建设、社商融合发展的一次有力尝试, 在发展之初存在政企边界不清、保障范围及力度有限等问题亟待解决。作者在厘清"惠民保"现状及问题的基础上, 通过梳理美国公共医疗保险Medicare Part C计划的社商合作管理经验, 提出我国应发挥有为政府与有效市场相结合优势、引导进行差异化产品设计、建立市场准入及评价机制, 以推动我国商业健康保险与基本医疗保险的有效衔接, 进一步降低人民群众就医负担。As a powerful attempt by government to promote the construction of the multi-level healthcare security system and social and commercial integration in China,"City-customized Medical Insurance"still has many problems to be solved at the beginning of its development,such as unclear boundary between government and enterprises,limited coverage and strength of security.On the basis of clarifying the current situation of"City-customized Medical Insurance",and combing the management experience of social and commercial integration in Medicare Part C plan of the United States,the authors put forward that China should make full use of the advantages of the combination of promising government and efficient market,guide differentiated product design,and establish market access and evaluation mechanism,so as to promote the effective connection between China′s commercial health insurance and basic healthcare insurance,and further reduce the people′s medical burden.

关 键 词：MEDICARE 社商融合发展 基本医疗保险 "惠民保" 优势互补 

分 类 号：F847.12[经济管理—保险] F842.6