利益相关者视阈下普惠型健康保险长效发展研究  

The Long-term Development of Inclusive Health Insurance from the Perspective of Stakeholders

作　　者：黄国武[1] 都豪 HUANG Guowu;DU Hao(School of Public Administration,Sichuan University,Chengdu 610065,China)

机构地区：[1]四川大学公共管理学院,成都610065

出　　处：《四川轻化工大学学报(社会科学版)》2025年第1期92-104,共13页Journal of Sichuan University of Science & Engineering:Social Sciences Edition

基　　金：国家社会科学基金项目(21XGL006)。

摘　　要：普惠型健康保险的发展有利于我国多层次医疗保障体系的完善,增强化解大病风险的能力,防止疾病脆弱群体因病致贫返贫,促进共同富裕。通过利益相关者“权力-利益”的研究框架,探究政府、参保人、保险公司之间权力与利益的作用关系,及其影响健康保险“普”和“惠”强弱的内在逻辑,发现目前普惠型健康保险参与主体存在“权-利”不均衡,制度发展面临不可持续的风险。未来政府应从目前的“强权力-弱利益”向“弱权力-弱利益”转变,并带动参保人向“强权力-强利益”以及保险公司向“强权力-弱利益”逐步转化,推动普惠型保险从形式普惠向实质普惠发展。发展思路上,政府从主导项目发展向监管服务转变,参保人从被动参保到主动参与,保险公司从依附基本医保向发挥保险精算优势发展。实现路径上,推动个税优惠与普惠健康保险衔接,明确最低赔付率提升产品质量,参保选择多档多元多样化,保障范围向非基本、目录外扩展。The development of inclusive health insurance is conducive to the improvement of China′s multi-level medical security system,enhancing the ability to resolve serious diseases risks,preventing disease-vulnerable groups from becoming poor and returning to poverty due to illness,and promoting common prosperity.Through the research framework of"power-interest"of stakeholders,the relationship between power and interests among the government,insured persons,and insurance companies is analyzed,and the internal logic that affects the strength of"universal"and"beneficial"health insurance is found.At present,there is an imbalance of"rights and interests"in the participants of inclusive health insurance,and the development of the system faces unsustainable risks.The results are:In the future,the government should change from the current"strong power-weak interests"to"weak power-weak interests",and drive the insured to gradually transform to"strong power-strong interests"and insurance companies to"strong power-weak interests"to promote inclusive insurance from formal inclusiveness to substantive inclusiveness.In terms of development ideas,the government has shifted from leading project development to regulatory services,insurance participants have changed from passive participation to active participation,and insurance companies have developed from relying on basic medical insurance to taking advantage of actuarial advantages.In terms of realization path,we should promote the connection between individual tax incentives and inclusive health insurance,clarify the minimum compensation rate to improve product quality,choose multiple levels of insurance to diversify,and expand the scope of coverage to non-basic and out-of-catalogue.

关 键 词：普惠型 健康保险 权力-利益 长效发展 惠民保 利益相关者 多层次医疗保障体系 

分 类 号：F842[经济管理—保险] F126