荷兰健康保险制度改革经验及启示

The experience of health insurance reform in Netherlands and its implications for China

文章对荷兰健康保险制度改革的历史过程以及现状进行描述分析,总结荷兰健康保险制度改革的特点:建立基于管理型竞争的强制性私立健康保险;私立保险方竞争获得更多的参保人员;政府对保险方和提供者的行为进行监管并提供相关信息;建立了风险均等化制度,消除不同保险方的风险差异。荷兰健康保险制度改革为我国健康保险制度进一步完善提供一些借鉴:消除不同健康保险制度的差距,保障一致性;建立风险均等化制度,调整不同基金池间的风险;商业保险机构参与经办健康保险管理服务;加强医保第三方对供方行为的制约和监督。

This paper reviews the history of health insurance reform in Netherlands and its current situation and provides some relevance as follows;based on managed competition and private institutions,Netherlands built compulsory health insurance system;private insurers competed to get more enrollees;government was responsible for the supervision of insurers and providers and providing related information;risk equalization system is set up to reduce the difference of risk in various insurers.Some experience and implications were referred to health insurance system improving in China：China should reduce the difference of various health insurance systems to ensure solidarity;build risk equalization mechanism to adjust the risk of different pooling fund;encourage private insurers to participate in managing health insurance;strengthen insurers＇ supervision and constraint to providers.