医疗保险公私合作的困境与出路

Dilemma and Way of Public-Private Cooperation in Medical Insurance

广东省一直在探索和创新医疗保险公私合作模式,从"湛江模式1.0"到"湛江模式2.0",提高了医疗保险的管理效率,但也面临制度定位不清晰、统筹层次不高、信息安全保障不够以及对第三方公司监管不足等问题。对此,政府可分类管理不同保险项目,把大病保险作为强制性补充项目完全交给商业保险公司经营,从区域一体化入手,逐步提高医疗保险的统筹层次,制定合理的公私利润分配制度,培育非营利组织等,同时加强信息安全管理,合理引导和监督第三方机构。

Guangdong has been exploring and innovating in the public-private partnership of medical insurance,from"Zhanjiang Model1.0"to"Zhanjiang Model 2.0",which has improved the management efficiency of medical insurance.However,it is also faced with some problems,such as unclear institutional positioning,low level of pooling level,inadequate information security and supervision of third-party companies.In this regard,the government can classify and manage different insurance projects,hand over serious illness insurance as a compulsory supplementary project to commercial insurance companies,gradually improve the pooling level of medical insurance from regional integration,formulate a reasonable public and private profit distribution system,cultivate non-profit organizations,etc.At the same time,strengthen information security management,and reasonably guide and supervise third-party organizations.