全过程健康风险管理激励路径选择与实现机制分析——基于商业保险承办社会医疗保险的视角

Analysis of Path Selection and Implementation Mechanism of Health Risk Management Incentives in the Whole Process——Based on the Perspective of Commercial Insurance Undertaking Social Medical Insurance

基于商业保险承办社会医疗保险的视角,比较分析了各种典型承办模式激励强度大小,探究了全过程健康风险管理激励的路径选择:再保险模式、长期合同和适宜规模。从公平竞争机制、费率动态调整机制、“保本微利”执行机制以及绩效评价机制4个方面,阐释了全过程健康风险管理激励的实现机制。

Based on the perspective of commercial insurance undertaking social medical insurance, the incentive intensity of various typical undertaking models is compared and analyzed, and the path selection of health risk management incentives in the whole process is explored, that is, reinsurance model and long-term contract should be chosen first. In the end, the realization mechanism of health risk management incentives in the whole process is explained which should include four aspects, such as fair competition mechanism, dynamic rate adjustment mechanism, “cost cover and small profit” implementation mechanism and performance evaluation mechanism.