商业健康保险发展思路探讨

An Exploration on Development of Commercial Health Insurance Business

我国是健康保险不发达国家,商业健康保险覆盖面较低。制约商业健康保险发展的宏观因素有:相关政策不明晰,商业健康保险规模小,地下保单在沿海地区比较猖獗;微观因素有:同业恶性竞争,产品同质化,道德风险存在,精算或经验数据缺乏基础,专业经营人才缺位。加快发展商业健康保险,必须寻求政策机遇;突破传统的"健康保障+健康管理"模式;建立商业保险公司与医疗机构之间的新型战略合作关系;实行专业化经营;提倡人性化服务;细分产品,有效控制风险;实施战略性人才储备。

Health insurance is gravely underdeveloped in China with low commercial health insurance coverage. Macro-factors restricting commercial health insurance development are unclear government policy, small size of commercial health insurance business and rampant expansion of underground insurance policy in coastal areas. On a micro-level, the restricting factors are vicious competition, product homogeneity, moral risks, lack of actuarial or experience data and lack of professionals in this area. To accelerate development of commercial health insurance business, we must seek policy opportunities, break from the traditional ＂health protection plus health management＂ model, establish strategic alliance between commercial insurers and medical institutions, introduce specialized operation, promote individualized service, segment insurance prod- ucts, effectively control risks, and pool up talented people.