上海市城镇居民大病保险实施评价

Evaluation of Urban Resident Medical Insurance for Catastrophic Diseases in Shanghai

目的:评估上海城镇居民大病保险政策效果和商业保险公司运行现状,为优化政策提供科学依据。方法:采用文献阅读、政策查阅、定量数据收集方法,收集自政策实施以来,即2014-2016年的大病医保数据和商业保险公司运行情况进行分析。结果:大病医保受益人数和人均补偿金额需有待提高,经办机构中两家公司业务量占总量的80%。结论:建议适度扩大病种,完善委托管理模式,发挥商业保险公司控费动力及定期开展第三方评估,提高保障的精准性。

Objective： To evaluate the policy effects of catastrophic diseases and the current operation situation of commercial insurance company for urban residents in Shanghai so as to provide scientific evidence Methods： Literature review, policy review and quantity data searching method were used to collect data of specific policy design for catastrophic diseases insurance and operation status of insurance companies from 2014 to 2016. Results： The number and the per eapita amount of compensation of catastrophic disease insurance benefits and needs to be improved. Two companies comprised 5% of the total volume. Conclusion： The diseases should be expanded moderately and improve the entrusted management mode to give full play to insurance companies effectively. The medical insurance for catastrophic diseases should be third-party assessed regularly to improve the precision.