摘要
目的: 研究普惠式健康险实现可持续发展的困难与对策。方法: 在“共富区”建设背景下,以宁波市为例,深入分析天一甬宁保的产品特点、面临挑战与存在问题,提出未来发展的建议。结果: 及结论：当前,天一甬宁保面临的主要挑战是“逆向选择”风险大、产品吸引力不足。具体问题包括赔付规则复杂、产品定位不明、激励机制缺失、支付效率不高以及政企责任不清。建议: 天一甬宁保应在发挥普惠功能的同时,回归一定的市场属性,通过实施产品责任分级、优化赔付规则、健全激励措施、创新支付方式、合理划分政企责任、优化风险管控机制等措施,有效提升产品吸引力。
Abstract
Objective: The paper studies the countermeasures for the sustainable development of inclusive health insurance. Methods: Under the Backgroundof “Demonstration Zone for Common Prosperity” Construction, this paper deeply analyzes the product characteristics, challenges, and problems of Tianyi Yongning Bao taking Ningbo City as an example, and puts forward suggestions for future development. Resultsand Conclusion: Currently, Tianyi Yongning Insurance is facing challenges mainly due to the high risk of "adverse selection" and the insufficient attractiveness of the product. Specific issues are complex compensation rules, unclear product positioning, lack of incentive mechanisms, low payment efficiency, and unclear responsibilities of government and enterprises. Suggestions: Tianyi Yongning Insurance should return to a certain market attribute while leveraging its inclusive function, which can be achieved through implementing product liability grading, perfecting compensation rules, improving incentive measures, innovating payment methods, reasonably allocating responsibilities between government and enterprises, optimizing product risk control mechanisms, to effectively improve attractiveness of the product.
关键词
普惠式健康险 /
惠民保 /
天一甬宁保 /
共富区
Key words
inclusive health insurance /
city-customized commercial health insurance /
Tianyi Yongning Insurance /
demonstration zone for common prosperity
赵静.
“共富区”建设背景下普惠式健康险发展路径研究——以天一甬宁保为例[J]. 中国医疗保险. 2025, 0(4): 113-119 https://doi.org/10.19546/j.issn.1674-3830.2025.4.015
Research on the Development Path of Inclusive Health Insurance Under the Background of "Demonstration Zone for Common Prosperity" Construction——Taking Tianyi Yongning Insurance as an Example[J]. China Health Insurance. 2025, 0(4): 113-119 https://doi.org/10.19546/j.issn.1674-3830.2025.4.015
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