商业保险机构参与新农合经办的条件与对策——基于6个典型地区的调研

The condition and countermeasure on the commercial insurance companies' participation for the New Rural Cooperative Medical Scheme:Based on the survey in six cities and counties

目的:通过分析商业保险机构参与新农合经办的效果,为商业保险机构介入新农合管理提出对策和建议。方法:选择新乡、江阴等商业保险机构参与新农合经办业务的六个市区进行现场调研,并与全国同期新农合运行指标进行了对比分析。结果:商业保险机构运行以来,新农合参合率不断提高,农民受益幅度得到提升,医疗费用得到了控制,农村卫生服务体系得到发展;但同时存在管理费到位滞后、人员不稳定、监管不到位等问题。结论:当基金超支严重、管理能力不足、信息系统不健全时,适宜引入商业保险机构经办新农合业务。商业保险机构更适合于大病补偿保险、新农合补充保险等业务。政府要通过招标方式选择保险公司,并对保险公司进行有效监管。

Objectives： In this paper, we analyze the effectiveness of commercial insurance model for the New Rural Cooperative Medical Scheme （NRCMS）. We also analyze problems with the model and explore countermeas- ures. Methods： We conducted a field survey in six cities and counties, including Xinxiang and Jiangyin, where com- mercial insurance companies participated in the NRCMS. We compared the results with a nationwide performance in- dex of the NRCMS over the same period. Resuhs ： The involvement of commercial insurance companies in the NRCMS has meant that participation in the NRCMS has increased, farmers have gained more, medical costs have been con- trolled, and the rural health service system has developed. Some problems that need addressing include delay of man- agement expenses and unsteady insurance company employees. Conclusions： Commercial insurance companies should been involved in the NRCMS when funds are being overspent, management is lacking, and information systems are incomplete. Commercial insurance companies are more suitable for serious illness compensation insurance. Govern- ment is responsible for selecting the insurance companies through the biding process and supervising them effectively.