目的: 结合地区实践,分析惠民保可持续发展所面临的挑战并提出建议。方法: 系统分析山东省16地市惠民保运营数据,总结成效与不足。结果: 惠民保发展存在参保率不高、稳定参保率难;普惠性与商业性之间界限不清,实现难度大;人群结构偏差难保证,“死亡螺旋”风险大等挑战。结论: 应厘清职责边界,发挥政府和市场的协同作用;强化政策支持,放开客户二次开发限制;实行人群分类、产品分层与报销分段相结合,精准化产品设计;加大服务加持,增强惠民保业务粘性。

Objective: Based on regional practice, the paper analyzes the challenges of city-customized commercial health insurance and puts forward suggestions. Methods: The operation data of city-customized commercial health insurance in 16 cities of Shandong Province were systematically analyzed, and the effectiveness and shortcomings were summarized. Results: The city-customized commercial health insurance has a low participation rate and difficulty in stabilizing the participation rate. The boundary between inclusiveness and commerciality is unclear, and it is difficult to achieve both of them. Also, it is difficult to ensure the deviation of the population structure and risk of the death spiral is high. Conclusion: We should clarify the boundaries of responsibilities and coordinate the government and the market, strengthen policy support and ease restrictions on secondary development of customers, implement a combination of population classification, product stratification, and reimbursement segmentation to achieve precise product design, increase service support and enhance the stickiness of business.