发达国家商业保险参与社会医疗保险的经验与启示

Experience and Enlightenment in the Developed Countries of the Commercial Insurance Involving in the Social Medical Insurance

各国公共医疗保障制度的改革都体现了商业保险参与的趋势。发达国家的医疗保障制度改革给中国的经验是:注重市场化、引入竞争机制;保持政府在公共医疗保障中的主导地位;发挥商业健康保险公司的专业化、市场化优势;完善管理式医疗服务。借鉴发达国家的经验,中国在推进商业健康保险参与社会医疗保险的过程中,要明确政府和市场的角色定位,积极培育商业健康保险市场,加强管理和监督,协调好商业保险和社会保险两种运行体制的关系。

There is a trend of participation of commercial insurance in the reform of the public medical insurance system. The experiences from the reform of social medical insurance in the developed countries are： pay attention to the market, introduce of competition mechanism; keep the leading role of the government in the public health care; play the professional and market advantages of the commercial health insurance company; develop the managed care services. So in the process of participation of commercial health insurance in the social medical insurance, we should make clear the role of government and market, Actively cultivate the commercial health insurance market, improve management and supervision, coordinate the relationship between commercial insurance and social insurance.