普惠型商业医疗保险的可持续性及影响因素研究  

Study on the Sustainability and Influencing Factors of Inclusive Voluntary Health Insurance

作　　者：陈星 张璐莹[1] 俞纯璐 童禧辰 陈文[1] CHEN Xing;ZHANG Luying;YU Chunlu;TONG Xichen;CHEN Wen(School of Public Health,Fudan University,Shanghai 200032,China;不详)

机构地区：[1]复旦大学公共卫生学院,上海200032

出　　处：《卫生经济研究》2025年第4期5-8,12,共5页

基　　金：国家自然科学基金“价值医疗导向下激励相容的支付体系研究”(72342016);国家自然科学基金“战略性购买视角下医保门诊按人头付费机制研究”(72374049)。

摘　　要：目的:分析普惠型商业医疗保险的运行情况及其影响因素,提出可持续发展建议。方法:收集2021—2022年全国普惠型商业医疗保险的运行情况等数据,采用t检验、卡方检验、二元Logistic回归方法,分析普惠型医疗保险可持续运行的影响因素。结果:2021年和2022年,全国共有324款普惠型商业医疗保险产品上市,其中76.85%实现可持续运行;政府支持、年筹资金额、参保率和平均报销比例是普惠型商业医疗保险可持续发展的影响因素。结论:通过加大政府支持力度、多渠道提升参保率、优化筹资机制与保障待遇设计,推动普惠型商业医疗保险可持续发展。Objective To analyze the sustainable operation of inclusive voluntary health insurance and quantify the influencing factors,and to provide a reference for promoting sustainable development of inclusive voluntary health insurance.Methods The data on the running characteristics,security coverage,financing level,security level,and survival situation of nationwide inclusive voluntary health insurance from 2021 to 2022 were collected systematically.The t-test,chi-square test,and binary logistic regression were used to analyze the influencing factors of the sustainability of inclusive voluntary health insurance.Results From 2021 to 2022,a total of 324 inclusive voluntary health insurance products were launched nationwide,of which 76.85%achieved sustainable operation.The regression analysis showed that government support,annual financing amount,enrollment rate,and average reimbursement rate were influencing factors for the sustainability of inclusive voluntary health insurance.Conclusion By strengthening government support,increasing the participation rate through multiple channels,and continuously optimize the financing mechanism and the design of protection treatment,the high-quality development of inclusive voluntary health insurance can be promoted.

关 键 词：普惠型商业医疗保险 可持续发展 影响因素 

分 类 号：F840.684[经济管理—保险]