目的: 分析商业医疗保险发展的制约因素,为商业医疗保险高质量发展提供依据和参考。方法: 基于主题框架分析法,对32名专业人员开展半结构化访谈,借助NVivo12 Plus软件,开展主题编码。结果: 商业医疗保险面临的困境包括：产品结构失衡、保障水平低、产品与需求不匹配、风险管理和精算技术弱等问题。进一步分析后确定21个分主题,7个主题。相关主题及分主题相互影响,共同作用,形成商业医疗保险发展困境因素模型。结论: 针对商业医疗保险面临的困境,提出相应对策建议：政策引领,推动商业医疗保险市场快速发展;以商业健康保险目录为抓手,促进商业医疗保险与社会医疗保险互补衔接;鼓励商保在细分领域的产品创新;保证普惠型商业医疗保险可持续性。
Abstract
Objective: This study attempts to analyze the constraints on the development of commercial health insurance, providing a basis and reference for the high-quality development of commercial health insurance. Methods: Using a thematic framework analysis, semi-structured interviews were conducted with 32 professionals. NVivo12 Plus software was employed for thematic coding. Results: The challenges faced by commercial health insurance include imbalanced product structure, low security levels, mismatch between products and demands, and weak risk management and actuarial techniques. After analysis, 21 sub-themes and 7 main themes were identified. These interconnected themes and sub-themes collectively contribute to the formation of a model outlining the factors hindering the development of commercial health insurance. Conclusion: In response to the challenges faced by commercial health insurance, corresponding strategic suggestions are proposed, including issuing policies to accelerate the rapid development of the commercial health insurance market, leveraging commercial health insurance catalogs to promote integration with social health insurance, encouraging innovation in product development within specialized areas of commercial health insurance, and ensuring the sustainability of inclusive commercial health insurance.
关键词
主题框架分析 /
商业医疗保险 /
模型构建
Key words
thematic framework analysis /
commercial health insurance /
model construction
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基金
上海交通大学医学院科技创新项目（人文社科类）“基于QCA方法的婴幼儿养育照护协同治理案例比较研究”（WK2320）
