我国健康保险业健康管理现状、问题与对策研究

Research on the Current Situation, Problems and Countermeasures of Health Management for Health Insurance Industry in China

健康管理的成功与否是保险公司的健康保险利润的重要影响因素。当前,我国正处于医疗体制改革的关键时期,健康保险如何与医院开展有效的管理衔接,即"健康保险的健康管理"成为了一项复杂的管理工程。文章分析了我国健康保险业健康管理现状及其面临的问题,如竞争与选择不足、信息系统平台尚未建立、可能来自医疗服务提供方的阻力以及保险公司微观管理能力欠缺等,并提出了试行和逐步推广管理型医疗(保险)方案、积极筹建和完善网络信息平台、政府作为以及创新财务制度等政策建议。

The success or failure of health management is the important factor of health insurance profits for the insurance compa-nies.Currently,it is the crucial period of health care system reform in China.How to develop effective management cooperation with hospitals,which is called ＂health management of health insurance＂,has become a complicated project.The current situation of health management is analyzed in health insurance industry in China.And the problems confronted are clarified,such as insufficient competition and selection,lack of information system,resistance from medical treatment service providers and insurance companies’ shortage of microcosmic management ability,etc.Some political suggestions are also put forward,such as developing managed care（insurance） projects gradually,setting up and improving information network platform,removing the resistance from medical treatment service providers under the support of the government,framing a developing programming of health insurance and innovating of the fi-nance system,etc.