The Challenges and Optimization Direction of City-Customized Commercial Health Insurance to Support the Rare Disease Guarantee&#x02014;&#x02014;From the Perspective of Collaborative Governance

doi:10.19546/j.issn.1674-3830.2024.9.016

China Health Insurance ›› 2024, Vol. 0 ›› Issue (9) : 111-123. DOI: 10.19546/j.issn.1674-3830.2024.9.016

The Challenges and Optimization Direction of City-Customized Commercial Health Insurance to Support the Rare Disease Guarantee——From the Perspective of Collaborative Governance

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Abstract

Drug guarantee for rare diseases is one of the important livelihood projects in China, and it is urgent for city-customized commercial health insurance to play a role in the multi-level healthcare security system for rare diseases. Based on the analysis of four operating modes of city-customized commercial health insurance and four guarantee methods of rare diseases, the paper proposes that guarantee of rare diseases in city-customized commercial health insurance is faced with challenges such as acceleration of the death spiral, as well as intensified conflicts of interest and trust crisis. From the perspective of collaborative governance, it is found that the root cause is insufficient coordination between the government and the market, including differences in objectives, insufficient mutual trust, logical conflicts, shifting of responsibility, limited incentives, ineffective co-construction, data barriers, and platform restrictions. On this basis, the paper proposes that the optimization path of rare disease guarantee in city-customized commercial health insurance requires the government to provide support that matches the functions of city-customized commercial health insurance. City-customized commercial health insurance should be further strengthened in expanding the coverage of rare disease guarantee and improving the benefits.

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city-customized commercial health insurance / rare disease / drug guarantee for rare diseases

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The Challenges and Optimization Direction of City-Customized Commercial Health Insurance to Support the Rare Disease Guarantee——From the Perspective of Collaborative Governance[J]. China Health Insurance. 2024, 0(9): 111-123 https://doi.org/10.19546/j.issn.1674-3830.2024.9.016

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