广东省商业保险承办大病医疗保险的实践研究

Practical research on serious illness medical insurance s undertaking by commercial insurance in Guangdong Province

总结了广东省在探索商业保险公司承办大病医疗保险的过程中,涌现出的湛江模式、珠海模式、江门模式等创新模式中的运作方式、盈利限制、经营收益等方面的共同点以及覆盖范围、筹资标准、模式特色等方面的差异性。提出多种大病医疗保险运营模式本质上都是一种政府购买服务,商业保险公司通过保险合同的方式参与社会医疗保险的运作,因各地对商业保险公司的盈利都做出了限制,目前商业保险公司的运营基本属于亏损,对制度的可持续运行也提出了挑战。建议进一步明确大病医疗保险的定位,慎重考虑大病医疗保险的未来发展方向,完善顶层制度设计。

In exploring the process of serious illness medical insurance s undertaking by commercial insurance in Guangdong Province,come forth the otherness of coverage area,funding standards,pattern characteristics and common ground of operation mode,profit limit,income from operation in which innovation model of Zhanjiang model,Zhuhai model,and Jiangmen model.It puts forward that medical insurance operation model of variety serious illness is kind of government purchase services.Commercial insurance companies participate in the operation of social medical insurance through insurance contracts.Because of the profit of commercial insurance companies has the limits in each local place,the operation of commercial insurance companies is belong to loss basically.This is a challenge to the sustainability of the system..The government must have clear position on medical insurance for serious illness,carefully consider future development direction,and improve the design of the top-level system.