中国商业健康保险面临的新常态及其引领

The new norms for China's commercial health-insurance development and its possible strategies

本文总结提炼了中国商业健康保险面临的6个新常态:卫生总费用快速增长,个人医疗费用负担较重;医保基金支出增长高于收入增长,从长期看面临收不抵支风险;基本医保面临"开源"和"节流"的双重困境;疾病谱剧变,死亡率下降,慢性病成主要死因;医疗信息化智能化产品和服务市场快速增长;跨界竞争加剧。提出商业健康保险可以发挥5个方面的作用:引导医师自由流动;助力分级诊疗体系;推动医药合理定价;优化多元办医格局;打造全周期健康服务。通过这些作用的发挥,商业健康保险可以引领和重塑、更新常态。

The paper generalizes six norms China＇s commercial health insurance faces, namely, rapid increase in total medical expenses with still heavy out-of-pocket payments ; the expenses of basic health insurance fund grows more rapidly than its financing ; basic insurance trapped into the double dilemmas of expanding source and reducing expenses ; the disease spectrum has switched to chronic ones which cause most deaths ; the market of smart medical care increases rapidly ; and many giants from other fields pour into the medical market. Accordingly , we propose that commercial insurance can play roles in ： （1 ） making the free flow of physicians ; （ 2） formation of stratified medical care system; （3） facilitating the rational pricing of medicines ; （4 ） contribute to the diversified hospitals and （5） forging industrial chain of health curing and care.