2020年以来,普惠型商业医疗保险产品凭借低门槛、低保费、高保障等优势获得了广泛关注。本文根据政府参与程度差异将普惠型商业医疗保险划分为政府主导型、政府指导型及政府支持型三种模式,结合地方实践对其代表性产品进行系统考察,认为政府介入程度不同的产品在普惠性上存在一定差异。基于此,本文结合我国台湾地区、美国以及新加坡推行普惠型商业医疗保险的经验,进一步提出补齐政策短板、政府积极引导、保险公司精细化运营等建议。
Abstract
Since 2020, inclusive commercial medical insurance products have gained lots of attention with the advantages of low threshold, low premium and high coverage. This article classifies inclusive commercial medical insurance into government-led, government-directed, and government-supported models based on differences in the degree of government involvement, and systematically examines their representative products in the context of local practices, concluding that products with different degrees of government involvement to some extent differ in terms of Inclusiveness. Based on this, this article combines the experience of Taiwan Province of China, the United States and Singapore in improving the Inclusiveness of commercial medical insurance, and further proposes to make up for the shortcomings of policies, offer active government guidance and support fine operation of insurance companies.
关键词
普惠型商业医疗保险 /
多层次医疗保障体系 /
运营模式
Key words
inclusive commercial medical insurance /
the multi-level healthcare security system /
operation mode
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 许闲. 探索发展到趋向成熟惠民保助力多层次医疗保障体系完善发展——《2022年城市定制型商业医疗保险(惠民保)知识图谱》解读[J].上海保险,2022,446(12):12-14.
[2] 《“惠民保”发展模式研究》课题组,金小桃,王琴,等.“惠民保”发展模式研究[J].保险研究,2022(01):3-20.
[3] 孙蓉,吴剑,崔微微.普惠保险及其发展水平测度[J].保险研究,2019(01):58-74.
[4] 王向楠,尹振涛.普惠保险模式及其在我国的进展[J].保险理论与实践,2019(03):91-110.
[5] 尹晔,许闲,王颖俐.我国区域普惠保险水平测度及影响因素分析[J].保险研究,2020(10):34-47.
[6] 陶圣禹,唐子佩.保险行业专题报告:惠民保再思考,普惠、共赢与可持续[R].上海:东方证券,2022.
[7] 冯鹏程,朱俊生.普惠补充医保:特征、方案比较与可持续发展[J].中国保险,2021,401(05):13-24.
[8] 深圳市医疗保障局.39元重疾险,政府惠民保平安[EB/OL].(2023-05-11)[2023-05-19].http://hsa.sz.gov.cn/ztzl/szsztdjbbcylx/.
[9] 深圳市医疗保障局.关于印发《深圳市重特大疾病补充医疗保险办法》的通知[EB/OL].(2020-04-15)[2023-03-24].http://hsa.sz.gov.cn/zwgk/zcfgjzcjd/gfxwj/content/post_7591607.html.
[10] 中国经营网.“惠蓉保”总参保人次突破1100万城市定制型补充医疗保险有望“下沉”[EB/OL].(2023-05-11)[2023-05-22].http://www.cb.com.cn/index/show/zj/cv/cv135210621262.
[11] 刘欣琪,谢雨晟.保险行业惠民保产品深度报告:东风已起,健康服务平台扶摇而上[R].上海:国泰君安证券,2021.
[12] 胡蓉.惠民保:惠民生惠发展[N].深圳商报,2023-05-10(A01).
[13] 陈婷婷,胡永新.赔付率不均爆款“惠民保”的AB面[J].决策探索(上),2021,No.704(11):38-39.
[14] 戴梦希.“惠民保”能否持续惠民仍需观察[N].金融时报,2021-09-22(008).
[15] 台湾地区卫生福利主管部门.https://www.mohw.gov.tw/mp–1.html.
[16] 台湾地区卫生福利事务主管部门.全民健康保险统计栏目[EB/OL].(2021-04-27)[2023-03-25].https://dep.mohw.gov.tw/DOS/np-1714-113.html.
[17] HARRY P SELKER, HARRY P SELKER, JUNE S WASSER.The Affordable Care Act as a National Experiment:Health Policy Innovations and Lessons[M].NY: Springer International Publishing,2014.
[18] U.S. Department of The Treasury, “Summarizes the U.S. Government’s Total Outstanding Debt at the End of Each Fiscal Year from1789 to the Current Year,” October 2,2020, https://fiscaldata. treasury. gov/datasets/historical-debt-outstanding/historical-debt-outstanding
[19] I GLENN COHEN, ALLISON K HOFFMAN, WILLIAM M SAGE. The Oxford Handbook of U.S.Health Law[M].NY: The Oxford University Press, 2017.
[20] LAWRENCE JACOBS, THEDA SKOCPOL.Health Care Reform and American Politics: What Everyone Needs to Know[M].NY: The Oxford University Press,2016.
