There is certain ambiguity in the hierarchical positioning of China's multi-level healthcare security system. This ambiguity, to a certain degree, hinders the enhancement of the system's guarantee efficiency. From a hierarchical perspective, this research constructs a theoretical framework of health "needs-demands- security". That is, the public's diverse health needs at different levels, when combined with their respective payment capabilities, are translated into differentiated health demands. These demands then drive multiple institutional forces to materialize health security. Drawing on international experience, this study delves into the adaptive arrangements of China's multi-level healthcare security system. Guided by the value orientation of "attaining efficiency while ensuring basic fairness", the triple-guarantee mechanism of the basic system is tailored to meet the basic medical needs. The aim is to fully safeguard the fundamentals and set a ceiling on personal out-of-pocket expenses. However, in the short term, it is imperative that programs such as city-customized commercial health insurance, employee mutual-aid security, and charitable medical assistance adapt to meet basic medical demands, thereby strengthening the support system for catastrophic diseases. Meanwhile, basic, mid-level, and high-end commercial medical insurances are respectively designed to address a wide range of health demands, including prevention and rehabilitation, comfortable medical services, and the self-actualization of health. Additionally, commercial disease insurance contributes to health security indirectly by fulfilling the financial security requirements, thereby working towards the goal of achieving more comprehensive "universal medical security". Based on these findings, this study puts forward several suggestions and considerations, including optimizing policies under the value orientation of hierarchical adaptation, establishing a 3 + N hierarchical collaborative governance mechanism, and refining hierarchical supply measures in line with health demands.
Key words
multi-level healthcare security system /
health needs /
commercial health insurance /
hierarchical adaptation
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References
[1] 中国发布.啥是“1+3+N”多层次医疗保障体系?国家医保局释疑-中国网[EB/OL].(2024-09-10)[2025-05-14].http://news.china.com.cn/2024-09/10/content_117419460.html.
[2] 胡宏伟,刘堂森.“1+3+N”多层次医疗保障体系协同发展研究——基于待遇给付视角[J].中国医疗保险,2025(4):5-12.
[3] THOMAS A, SPATARO L.The effects of pension funds on markets performance: a review[J]. Journal of economic surveys, 2016, 30(1): 1-33.
[4] 张宗良,褚福灵.中国多层次医疗保障体系再思考——兼析补充保障的模式创新与协同发展[J].经济社会体制比较,2023(1):79-92.
[5] 龚曦,王红波.整体性治理视域下多层次医疗保障体系的概念厘定、发展困境及路径选择[J].中国卫生政策研究,2024,17(2):1-8.
[6] 郑功成.中国式现代化与多层次医疗保障体系建设[J].学术研究,2023(9):80-86+178.
[7] 许飞琼. 中国多层次医疗保障体系建设现状与政策选择[J].中国人民大学学报,2020,34(5):15-24.
[8] 黄国武. 中国多层次医疗保障发展思辨:基本多层向多元多层转型[J].社会保障评论,2022,6(4):67-82.
[9] 赵亚宁. 多层次医疗保障的体系整合与制度衔接——以健康权实现为中心[J].保险研究,2025(3):19-30.
[10] 田蒙蒙. 基本医疗保险“保基本”的法理重释[J].社会科学战线,2024(1):209-218.
[11] 田蒙蒙.基本医疗保险费用共付机制研究[J].医学与社会,2023,36(7):103-107+115.
[12] 李珍,蒋浩琛.政治结构与利益博弈的产物:美国联邦医疗保险的性质变迁[J].社会保障评论,2025,9(2):132-146.
[13] 许闲,林陈威,尹轶帆.中国商业健康保险发展:演进与创新——基于2009—2022年中国医疗保险条款数据的分析[J].复旦学报(社会科学版),2023,65(5):181-190.
[14] 王嘉韵,王力男,朱碧帆,等.发展衔接基本医保商业健康保险:国际做法与启示[J].中国卫生经济,2024(10):1-6.
[15] 张笑天,张志叶,赖晓波.商业健康保险在多层次医疗保障体系中的发展方向、定位和策略——以珠海市惠民保发展实践为例[J].中国医疗保险,2023(9):113-117.
[16] 杨燕绥,秦晨,于淼,等.相互保式惠民保是医疗保险第二支柱[J].保险理论与实践,2024(8):1-15.
[17] 王海漪. 慈善医疗的发展规律、现实困境与路径选择[J].学术研究,2023(10):101-107.
[18] 王增文. 多层次医疗保障筹资的理论逻辑及实现路径[J].社会保障评论,2023,7(4):99-113.
[19] 费太安.健康中国百年求索——党领导下的我国医疗卫生事业发展历程及经验[J].管理世界,2021,37(11):26-40+3.
[20] 李珍,王怡欢.论基本医疗保险与商业健康保险的定位与衔接[J].中国卫生政策研究,2020,13(1):9-14.
[21] 孙淑云. 多层次医疗保障体系化的法律调整与优化重塑[J].甘肃社会科学,2024:1-12.
[22] GROSSMAN, MICHAEL.On the concept of health capital and the demand for health[J]. Journal of political economy, 1972, 80(2): 223-255.
[23] GROSSMAN M.The demand for health turns 50: reflections[J]. Health economics, 2022, 31(9): 1807-1822.
[24] GALAMA T, KAPTEYN A.Grossman’s missing health threshold[J]. Journal of health economics, 2011, 30(5): 1044-1056.
[25] LILJAS B.Insurance and imperfect financial markets in Grossman’s demand for health model-a reply to tabata and ohkusa[J]. Journal of health economics, 2000, 19(5): 821-827.
[26] CHEN W.The extended grossman human capital model with endogenous demand for knowledge[J]. International review of economics & finance, 2024, 95: 103464.
[27] CULYER A.Need-the idea wont do-but we still need it[J]. Social science and medicine, 1995, 40(6): 727-730.
[28] 胡家祥. 马斯洛需要层次论的多维解读[J].哲学研究,2015(8):104-108.
[29] 祝永庆,刘民权.生活质量评估主客观福利的机理分析[J].人文杂志,2021(2):39-48.
[30] KAHNEMAN D, TVERSKY A.Prospect theory-analysis of decision under risk[J]. Econometrica, 1979, 47(2): 263-291.
[31] TVERSKY A, KAHNEMAN D.Advances in prospect-theory-cumulative representation of uncertainty[J]. Journal of risk and uncertainty, 1992, 5(4): 297-323.
[32] LEWIS P M, ROSE R, SHIRATORI R.The welfare state east and west[J]. The journal of asian studies, 1988, 47(2): 382.
[33] PILDES R, ANDERSON E.Slinging arrows at democracy-social choice theory, value pluralism, and democratic-politics[J]. Columbia law review, 1990, 90(8): 2121-2214.
[34] 胡宏伟,刘堂森.惠民保支持罕见病保障的现实挑战与优化方向——基于协同治理的视角[J].中国医疗保险,2024(9):111-123.
[35] 杨穗,赵小漫.走向共同富裕:中国社会保障再分配的实践、成效与启示[J].管理世界,2022,38(11):43-56.
[36] 申曙光. 我们需要什么样的医疗保障体系?[J].社会保障评论,2021,5(1):24-39.
[37] 王嘉韵,王力男,朱碧帆,等.发展衔接基本医保商业健康保险:国际做法与启示[J].中国卫生经济,2024,43(10):1-6.
[38] FURUKAWA M F, MACHTA R M, BARRETT K A, et al.Landscape of health systems in the United States[J]. Medical care research and review, 2020, 77(4): 357-366.
[39] 张欣桐,吕兰婷.新加坡多层次医疗保障体系特点及启示[J].中国医疗保险,2024(11):117-125.
[40] MOEHLER M.Diversity, stability, and social contract theory[J]. Philosophical studies, 2019, 176(12): 3285-3301.
[41] DANIELS N.Just health: replies and further thoughts[J]. Journal of medical ethics, 2009, 35(1): 36-41.
[42] 药渡数据.数说2024的国谈,评审通过率又低了?[EB/OL].(2024-12-19)[2025-06-21].https://baijiahao.baidu.com/s?id=1818830113787367758&wfr=spider&for=pc.
[43] 国家医疗保障局.国家医保局召开医疗救助信息管理服务平台启动暨支持慈善组织参与西藏日喀则地震医疗救助工作会[EB/OL].(2025-01-10)[2025-07-13].https://www.nhsa.gov.cn/art/2025/1/10/art_14_15430.html.
