新医改框架下我国商业健康保险发展策略探讨——国际经验和中国模式

Development strategy of commercial health insurance in China under the framework of New Health Reform——International experience and China model

我国商业健康保险市场虽饱受政府重视,但却始终发育不足。相当重要的一个原因是简单逐利,并不兼顾社会需求,忽略医疗保险源自社会互助的历史渊源,也就缺乏科学的发展模式。从国际看,在私营医疗保险发挥重要作用的国家,其私营医疗保险市场构成主体、管理费用、保险合同类型、费率设定方式、专业化程度等都与我国存在较大的差异,其背后的原因是制度所遵循的价值理念和发展方式的不同,特别是对制度目标的认识。因此,本文提出一系列方法,淡化我国商业健康保险市场的盈利动机,使其注重社会公众利益与其利润的共同实现,从而使整个市场走上科学的发展道路,更好的完成自己作为公立计划补充的角色。

The commercial health insurance industry in China still remains underdeveloped even though it enjoys huge attentions and government policy support. One of the vital reasons is it puts too much emphasis on profit-making, but ignores the social demandes. Ignoring its social mutual origin, the industry lacks a scientific model of development. According to international experiences where private health insurance plays an important role, the private health care providers are very different from China in aspects of participants, administrative costs , types of contact, measures of premium rates and level of specialization. This significant difference is mostly due to the fact that its market value and development pathway of the two systems are different, especially the perception on the system objectives. Therefore, this paper offered a set of methods to weaken the profit-pursuing motivation of the private health insurance market and make the participants pay equal attention to their corporate profits and community welfare. Thus driving the private health insurance market into a scientific and suitable development pathway, and better play its supplementary role to social heahhcare system.