商业健康险与社会医疗保险协调运作研究——与奥巴马医改方案相比照

Research on the Coordinative Operation of Commercial Health Insurance and Social Medical Insurance——Compared with the Obama Healthcare Reform Act

在我国全民医保体系下,商业健康险的发展趋势是演变为社会医疗保险的耦合体,研究两者如何协调运作势在必行。"耦合"这个概念运用到保险学上,可理解为两个或两个以上的险种在调剂余缺、资源互补上存在紧密配合和相互影响,通过相互作用从一侧向另一侧传输保险资金,再由相反方向从另一侧向该侧让渡保险资源,共同促进广大受众的健康和医疗需求与有效保险保障的对接。本文通过挖掘奥巴马医改方案中有利于国计民生的亮点,根据其对我国协调发展健康险和社会医疗保险的启示,提出四点政策建议。

Under the nationwide health-insurance system of China, the commercial health insurance faces the tendency to become the coupling of social medical insurance, and it is necessary to find out how they could coordinate with each other. The concept ＂COUPLING＂ applied to insurance study can be understood as that 2 or 2 more types of insurances interact and coordinate with each other in supplies regulating and resource complementary by exchanging insurance funds and insurance service resources. It aims to jointly promote the connection of health and medical needs from the insured and effective insurance coverage. This paper digs out the bright points, which are beneficial to national welfare and people＇s livelihood, from Obama Health Insurance Reform Act, to put forward 4 pieces of policy suggestions based on the enlightenment for the coordinative development of health insurance and social medical insurance in China.