商业健康保险与公立医院协同发展的问题分析与建议:以上海市为例

Analysis and Suggestions on the Synergistic Development of Private Health Insurance and Public Hospitals:A Case Study of Shanghai

构建多层次医疗保障制度体系能够满足人民群众多样化、个性化的医疗服务需求。公立医院作为我国医疗服务的主体,与商业健康保险(以下简称商保)有效衔接,能够加快优质医疗服务落地,促进创新发展。商保能够优化产品保障,提高运营效率,实现双赢。文章以上海市作为研究对象,基于人口特征、经济水平、医疗资源、政策环境分析上海市对于多层次医疗保障的供求现状,定位现阶段公立医院与商保合作的困难与瓶颈。提出探索放宽特需服务自主发展空间、提升商业健康保险机构与公立医院健康管理服务衔接水平、加强数据管理与共享、加强商保对于创新药械的保障等建议,以推进商保与公立医院协同发展。

Constructing a multi-tiered healthcare security system can meet the diverse and individualized healthcare service demand of the general public.Public hospitals,as the main providers of healthcare services in China,effectively integrate with commercial health insurance,which can accelerate the implementation of high-quality healthcare services,promote innovative development,and optimize product coverage and operational efficiency for commercial health insurance,achieving a win-win situation.Taking Shanghai as the research object,it analyzes the supply and demand status of multi-tiered healthcare security in Shanghai based on population characteristics,economic level,healthcare resources,and policy environment.It identifies the difficulties in the current collaboration between public hospitals and commercial insurance.Finally,it proposes exploring the expansion of independent development space for specialized services,improving the level of coordination between commercial insurance institutions and public hospitals in health management services,promoting the management and sharing of data,strengthening the protection of innovative medicines and devices by commercial insurance,in order to promote the coordinated development of commercial insurance and public hospitals.