商业健康保险与医药产业合作现状、问题以及协同发展建议:以上海市为例  

The Current Status,Issues,and Policy Recommendations for the Cooperation between Private Health Insurance and the Pharmaceutical Industry:A Case Study of Shanghai

作　　者：王嘉韵 金春林[1] 宋文华 王力男[1] 陈珉惺[1] Wang Jiayun;Jin Chunlin;Song Wenhua(Shanghai Health Development Research Center(Shanghai Medical Science and Technology Institute),Shanghai,200040,China;不详)

机构地区：[1]上海市卫生和健康发展研究中心(上海市医学科学技术情报研究所),上海200040

出　　处：《中国卫生经济》2024年第10期15-19,共5页Chinese Health Economics

基　　金：上海市发展和改革委员会委托项目(20230701)。

摘　　要：在对上海市进行实地调研的基础上,文章从供给侧视角审视了商业健康保险(以下简称商保)与医药产业合作的现状,探讨合作中存在的问题,进而提出两者协同发展的建议。研究发现,商保与医药产业的合作主要有3种模式,具体内容如下:“社商”融合的惠民保、保险公司牵头的特药险、药企牵头的带病体保险。然而,这些模式普遍面临政策支持有限、合作规范性缺失、信息与数据交流不足、创新支付模式不成熟、创新药落地难等问题。文章认为,协同发展的关键在于利用商业健康保险的战略购买力,制定合理的支付策略和标准,使“险、企、医、患”多方共赢,进而从建立机制、打破壁垒、战略购买、配套措施4个维度提出商保与医药产业协同发展的建议。Based on on-site research in Shanghai,it takes a supply-side perspective to examine the current status of cooperation between Private Health Insurance(PHI)and the pharmaceutical industry.It discusses the issues existing in the cooperation and proposes policy recommendations for their coordinated development.It identifies three main cooperation models and products,which are the public-private integrated product"Hui Min Bao",the special drug insurance led by insurance companies,and the disease insurance for patients led by pharmaceutical enterprises.However,these models commonly face challenges such as the limited policy support,a lack of standardized cooperation between the two sectors,insufficient information and data exchange,immature innovative payment models,and difficulties in the application of innovative drugs.It argues that the key to coordinated development lies in leveraging the strategic purchasing power of PHI,devising rational payment strategies and standards to achieve a win-win situation for insurers,enterprises,healthcare providers and patients.Therefore,policy recommendations are proposed from the perspectives of establishing mechanisms,breaking barriers,strategic procurement,and supporting measures.

关 键 词：商业健康保险 医药产业 合作模式 协同发展 上海 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.684[经济管理—保险]