摘要
目的: 重新审视商业保险发展的逻辑与空间,进而探讨对策与路径。方法: 构建“需求—供给—支付—保险”分析框架,建立医疗服务供需保障模型,从专业性、便捷性、创新性、舒适性四个维度分析商业保险发展的切入口和生长点。结果: 从专业性到便捷性、创新性和舒适性,直接作用于疾病治疗效果的相关性逐渐降低,民生基本性程度相应下降,反之则相应上升。结论: 基本医保保障功能应随民生基本性的下降而减弱,商业保险作用应相应增强;商业保险保障重点应侧重于群众便捷性、创新性、舒适性需求与供给产生的相应支付。
Abstract
Objective: The paper re-examines the logic, space of the development of commercial insurance, further explores countermeasures, paths. Methods: The paper constructs a "demand, supply, payment, insurance" analysis framework, establishes a medical service supply, demand security model, analyzes the breakthrough points, growth points of commercial insurance development from dimensions of professionalism, convenience, innovation, comfort. Results: From professionalism, convenience, innovation, to comfort, the correlation directly affect the effectiveness of disease treatment gradually decreases, the degree of basic livelihood decreases accordingly. Conversely, the correlation, degree increases. Conclusion: The security function of basic medical insurance should weaken with the decline of people's basic livelihood, the role of commercial insurance should be correspondingly enhanced. The focus of commercial insurance security should be the corresponding payments generated by the demand, supply of convenience, innovation, comfort for the public
关键词
医疗服务 /
需求 /
供给 /
支付 /
商业医疗保险
Key words
medical services /
demand /
supply /
payment /
commercial health insurance
刘源.
医疗服务供需保障模型与商业保险发展空间分析[J]. 中国医疗保险. 2025, 0(3): 85-91 https://doi.org/10.19546/j.issn.1674-3830.2025.3.011
Analysis of the Supply and Demand Security Model of Medical Services and the Development Potential of Commercial Insurance[J]. China Health Insurance. 2025, 0(3): 85-91 https://doi.org/10.19546/j.issn.1674-3830.2025.3.011
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 国家金融监督管理总局.2024年12月人身险公司经营情况表[R/OL].(2025-01-26)[2025-03-12].https://www.nfra.gov.cn/cn/view/pages/ItemDetail.html?docId=1197407&itemId=954.
[2] 国家金融监督管理总局.2024年12月财产保险公司经营情况表[R/OL].(2025-01-26)[2025-03-12].https://www.nfra.gov.cn/cn/view/pages/ItemDetail.html?docId=1197406&itemId=954.
[3] 人民政协网.中国医疗保障发展报告(2023):多层次医疗保障体系建设与发展[EB/OL].(2023-12-26)[2025-03-11].https://www.rmzxw.com.cn/c/2023-12-26/3466576.shtml.
[4] 苏泽瑞.普惠性商业健康保险:现状、问题与发展建议[J].行政管理改革,2021,(11):90-99.
[5] 周延礼.周延礼谈商业健康险发展难题:供需不匹配、经营能力不足、协同功能发挥不充分[N].经济观察报,2022-12-14.
[6] 中国政府网.国务院办公厅关于加快发展商业健康保险的若干意见[R/OL].(2014-11-17)[2025-03-11].https://www.gov.cn/zhengce/content/2014-11/17/content_9210.htm.
[7] 光明网.英媒:英国人急诊室候诊超12小时[EB/OL].(2025-02-02)[2025-03-11].http://m.toutiao.com/group/7466719160202986034/?upstream_biz=doubao.
[8] 国家医疗保障局.国家医保局出席国新办“推动高质量发展”系列主题新闻发布会[R/OL].(2024-09-10)[2025-03-11].https://www.nhsa.gov.cn/art/2024/9/10/art_14_13819.html.
[9] 中国政府网.国家区域医疗中心125个建设项目落地实施——让更多人共享优质医疗资源[R/OL].(2024-10-23)[2025-03-11].https://www.gov.cn/yaowen/liebiao/202410/content_6982227.htm.
[10] 光明网.“病人住院时间越长医院亏得越多”症结何在[EB/OL].(2024-10-16)[2025-03-11].https://m.baidu.com/bh/m/detail/ar_8818705878810885889.
[11] 宜兴市人民政府.一年住院16次近200 天?——异常高住院率背后的故事[R/OL].(2025-02-07)[2025-03-11].http://www.yixing.gov.cn/doc/2025/02/07/1259362.shtml.
[12] 广东省人民政府.广东省医疗保障局关于印发《广东省医疗保障基金使用监督管理行政处罚裁量权适用规则》的通知[EB/OL].(2023-01-17)[2025-03-11].https://www.gd.gov.cn/zwgk/gongbao/2023/3/content/post_4089703.html.
[13] 羊城晚报.共绘湾区医疗服务新蓝图——佛山禅医国际医疗商业保险服务中心启幕[EB/OL].(2025-01-01)[2025-03-11].http://m.toutiao.com/group/7454865609185165862/?upstream_biz=doubao.