多层次保障体系下城市定制型商业医疗保险保障研究  

Research on the City-Customized Commercial Medical Insurance Under China's Multi-Level Security System

作　　者：刘阳 郭珉江[1] 李亚子[1] 张小娟[1] 曹晓琳 姜骁桐 

机构地区：[1]中国医学科学院医学信息研究所健康与医疗保障中心,北京100020

出　　处：《中国医疗保险》2024年第3期106-113,共8页China Health Insurance

基　　金：国家医疗保障局委托项目“全国惠民保运营监测和跟踪评价研究”。

摘　　要：目的:分析2022年全国惠民保产品政策与产品定位,为推动惠民保的健康发展提供政策建议。方法:运用政策对比分析和情景分析,模拟测算我国东、中、西部地区典型城市惠民保对不同医疗费用水平对象的保障效果。结果:惠民保的保障范围包括目录内保障、目录外保障、特药保障、增值服务四个方面;惠民保对基本医保有补充功能;不同地区基本医保的保障水平不同,造成对惠民保的保障需求不同。结论:多层次医疗保障体系下惠民保的补充保障效应逐渐显现;惠民保的产品设计需遵循市场规律,因地制宜发挥惠民保的保障作用;同时需提升产品价值,保障范围可以从医疗保障延伸至健康保障。Objective:The paper analyzes the policies and positioning of city-customized medical insurance in 2022,and provides suggestions for promoting the development of city-customized medical insurance.Methods:Through the policy comparative analysis and scenario analysis,the security effect of city-customized medical insurance in typical cities in the eastern,central and western regions on different medical cost levels was measured.Results:The coverage of city-customized medical insurance includes four aspects,i.e.in-catalogue drugs,out-ofcatalogue drugs,special medicine and value-added service.City-customized medical insurance and is supplementary to basic medical insurance.Different regions have different security levels in basic medical insurance,resulting in different security needs for city-customized medical insurance.Conclusion:The supplementary security effect of city-customized medical insurance under the multi-level medical security system is obvious.City-customized medical insurance needs to follow market rules in the product design and play its role according to local conditions.At the same time,it is necessary to enhance the value of products,whose coverage can be extended from medical insurance to health insurance.

关 键 词：城市定制型商业医疗保险 多层次医疗保障体系 保障待遇 定位与衔接 

分 类 号：F840.684[经济管理—保险]