商保目录的国际经验及启示  

International Experience and Inspiration of Commercial Insurance Catalog

作　　者：冯鹏程 

机构地区：[1]泰康养老山东分公司,济南250001

出　　处：《中国医疗保险》2025年第2期19-27,共9页China Health Insurance

摘　　要：随着我国商业健康保险在多层次医疗保障体系中的价值凸显,保险业在积极寻求与医药器械等产业的生态合作。为推动商业健康保险向长期化、多元化、可持续方向转型,有必要建立体系化的商业健康保险目录。本文分析美国、澳大利亚、加拿大、德国等国家建立商保目录的做法,总结其经验,认为商保目录是商业健康保险高质量发展的体现,与医保稳定成熟呈正相关关系,可有效支撑客户需求和多方平衡等特点。同时,从分级支付的目录精细化管理方式、组建第三方组织、允许目录外保障的多样化、在惠民保中优先建立丙类药品目录等方面提出我国商保目录的建立建议。With the prominent value of commercial health insurance in China's multi-level healthcare security system,the insurance industry is actively seeking ecological cooperation with industries such as medical equipment.To promote the transformation of commercial health insurance to be long-term,diversified,and sustainable,it is necessary to establish a systematic commercial health insurance catalog.This article analyzes the practice of establishing commercial insurance catalogs in the United States,Australia,Canada,and Germany,and summarizes their experience.It believes that commercial insurance catalog is a reflection of the high-quality development of commercial health insurance,and is positively correlated with the stability and maturity of basic medical insurance,also it can effectively meet the needs of customers and achieve multi-party balance.At the same time,suggestions were put forward for the establishment of China's commercial insurance catalog,including implementing a refined catalog management approach of graded payment,establishing third-party organizations,approving diversified security outside the catalog,and prioritizing the establishment of a Class C drug catalog in the city-customized commercial health insurance.

关 键 词：商保目录 商业健康保险 国际经验 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]