惠民保支持罕见病保障的现实挑战与优化方向——基于协同治理的视角

The Challenges and Optimization Direction of City-Customized Commercial Health Insurance to Support the Rare Disease Guarantee--From the Perspective of Collaborative Governance

罕见病用药保障是我国重要的民生工程之一,在罕见病多层次医疗保障体系中亟须惠民保发力。本文在分析惠民保四种运行模式、罕见病四种保障方式的基础上,提出惠民保罕见病保障面临“死亡螺旋”加速、利益冲突激化、信任危机加剧等挑战。从协同治理的视角分析,其根本原因在于政府与市场协同不充分,包括目标分歧和互信不足、逻辑冲突和责任推诿、激励有限和共建不力、数据壁垒和平台限制。在此基础上,本文提出惠民保罕见病保障的优化路径需要政府提供与惠民保政策功能相匹配的支持,惠民保在罕见病保障扩面、待遇提升两方面还应进一步强化。

Drug guarantee for rare diseases is one of the important livelihood projects in China,and it is urgent for city-customized commercial health insurance to play a role in the multi-level healthcare security system for rare diseases.Based on the analysis of four operating modes of city-customized commercial health insurance and four guarantee methods of rare diseases,the paper proposes that guarantee of rare diseases in city-customized commercial health insurance is faced with challenges such as acceleration of the death spiral,as well as intensified conflicts of interest and trust crisis.From the perspective of collaborative governance,it is found that the root cause is insufficient coordination between the government and the market,including differences in objectives,insufficient mutual trust,logical conflicts,shifting of responsibility,limited incentives,ineffective co-construction,data barriers,and platform restrictions.On this basis,the paper proposes that the optimization path of rare disease guarantee in city-customized commercial health insurance requires the government to provide support that matches the functions of city-customized commercial health insurance.City-customized commercial health insurance should be further strengthened in expanding the coverage of rare disease guarantee and improving the benefits.