社会保险与商业保险在医疗保障体系中互促共进

Medical Security:the Mutual Promotion of Social I nsurance and Commercial I nsurance

在医疗保障体系中,社会保险和医疗救助属于基本保障,互助合作保险和商业保险等属于补充性保障。社会医疗保险的责任范围和保障水平须根据老百姓的疾病风险保障需求和政府基本职责、并通过法律程序来确定。商业保险则为具有购买能力的社会成员提供社会医疗保险责任范围之外、保障水平之上的那部分风险的保障服务。因此,保险公司需要加强需求分析、设计和开发医疗保险产品,并在管理和人才方面与之相适应。政府及其部门则要秉持"保基本"的原则,积极推进"制度全覆盖"走向"人员全覆盖",并积极探索医疗保险服务机制创新。

In the medical security systems, social insurance and medical assistance are basic security system, while cooperative insurance and commercial insurance are supplementary insurance system. The limitation of liability and benefit level of social medical insurance depend on people＇s security requirements against disease risk and the government＇s fundamental responsibility, which must be determined by legal procedures. While commercial insurance provides security for those who can afford programs covering more benefits and withstanding higher risks beyond the social medical insurance. Therefore, the commercial insurance companies have to strengthen demand analysis and product design. Besides, they must improve their management level and talent team. The government departments need to grasp the principle of ＂basic security＂, promote the transformation from ＂full-covered system＂ to ＂ universal coverage＂, and explore the system innovation of medical insurance.