商业健康保险在多层次医疗保障体系中的发展方向、定位和策略——以珠海市惠民保发展实践为例  

The Development Direction,Positioning,and Strategy of Commercial Health Insurance in a Multi-Level Medical Security System

作　　者：张笑天 张志叶 赖晓波 

机构地区：[1]珠海医疗保险研究会,珠海519000 [2]中国人寿保险股份有限公司珠海分公司,珠海519000

出　　处：《中国医疗保险》2023年第9期113-117,共5页China Health Insurance

摘　　要：我国有关部门先后出台了多项政策文件,积极支持商业健康保险发展,但其在我国多层次医疗保障体系中的补充保障作用仍有待提高。近年来,普惠性城市定制型商业医疗保险(以下简称定制险)不断发展,进一步提升了参保群众的医疗保障水平,但同时也面临保险领域“死亡螺旋”风险等困境。珠海市定制险参保率稳定在48%左右,保障项目延伸到了重大疾病的“早查早治”等领域,其核心机制源于政商协同的非营利操作模式。本文认为商业健康保险未来的发展主体方向应是大力发展定制险,明确将其与传统商业健康保险的功能定位进行区别,制定单独的发展策略,创新开展健康管理和实施管理式医疗。China's relevant departments have successively issued multiple policies to actively support the development of commercial health insurance,but its supplementary role in China's multi-level medical security system still needs to be improved.In recent years,inclusive city-customized commercial medical insurance(customized insurance)has been continuously developing,further improving the medical security level of insured people,but at the same time,it also faces the"death spiral"risk in the insurance field.The participation rate of customized insurance in Zhuhai City has remained stable at around 48%,and the insurance content has extended to areas such as"early detection and treatment"of major diseases.Its core mechanism stems from the non-profit operation model of government and business cooperation.This article believes that the future development direction of commercial health insurance is to develop customized insurance,clearly distinguish its functional positioning from traditional commercial health insurance,formulate separate development strategies,innovate health management,and implement managed healthcare.

关 键 词：商业健康保险 普惠险 非营利保险 管理式医疗 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]