公立医院开展商业健康保险合作实践与探索

Practice and exploration of commercial health insurance cooperation in public hospitals

随着医改不断深入,“健康中国”战略相关配套政策的发布,全社会健康意识明显增强,鼓励商业健康保险与医疗机构多种形式的创新合作,给商业健康保险的发展提供了重大契机,其市场份额和发展速度均明显高于保险业整体水平。作者基于北京市某大型三甲综合医院,立足公益性原则,保证基本医疗的前提下,介绍该公立医院与商业健康保险合作的探索与实践过程,供同类公立医院开展商业健康保险合作提供研究案例。研究显示,开展商业健康保险合作首先要处理好基本医疗服务与商业保险医疗服务关系,合作双方要充分满足患者个性化健康需求;探索建设商业健康保险统一结算平台,提升客户体验,优化资源配置,同时在广度和深度方面挖掘商业健康保险的保障作用。

With the continuous deepening of medical reform in our hospital,the release of the“Healthy China”strategy-related supporting policies has significantly enhanced the health awareness of the whole society.Encouraging commercial health insurance and various forms of innovative cooperation among medical institutions has provided a major opportunity for the development of commercial health insurance.Its market share and development speed are significantly higher than the overall level of the insurance industry.Under this background,this paper is based on a large-scale top three hospital in Beijing,based on the principle of public welfare,to ensure the basic medical care,to introduce the exploration and practice of the cooperation between the public hospital and commercial health insurance,for commercial health insurance of similar public hospitals.Collaborate to provide research cases.Results To carry out commercial health insurance cooperation,we must first handle the relationship between basic medical services and commercial medical services.The partners must fully meet the individualized health needs of patients.Suggestions Explore the establishment of a unified settlement platform for commercial health insurance,improve customer experience,optimize resource allocation,and tap the role of commercial health insurance in terms of breadth and depth.