公立医疗保险制度与商业健康保险筹资关系探讨——基于七国的比较研究

An Analysis of Relationship between Social Health Insurance and Private Health Insurance in an International Context

公立医疗保险制度和商业健康保险是国家医疗保障体系的两种重要筹资方式,以政府为主导的公立医疗保险制度是基础,商业健康保险在前者未覆盖领域寻求逐利空间。世界上7个典型国家的医疗筹资实践与筹资方式的强弱组合关系可以归纳为四种类型:公立医疗保险制度垄断模式、基本险与附加险模式、共同保险模式和再保险模式。不同模式的选择受国家政治体制、经济实力、医疗卫生政策等因素的综合影响。公立医疗保险制度和商业健康保险的分工合作,可为全体社会成员提供更完善高效的医疗保障,亦有助于增进病患福利。

social health insurance and private health insurance are two essential financing approaches in a nation＇s health sys-tem. Social health insurance schemes serve as the fundamental financing approach,while private health insurance plans chase profit beyond basic universal coverage. This paper investigates the relationship with seven countries＇ practices, demonstrating that there are mainly four modes, ＂social health insurance monopoly＂, ＂basic and supplementary insurance＂, ＂coinsurance＂ and ＂reinsurance＂. Besides,we argue that different types of modes depend on the level of economic development, political system and nation＇s health policy. Moreover ,the cooperation between social and private health insurance could provide more effective medical services to all the individuals, and improve their benefits.