基于福利多元视角的城市定制型商业医疗保险主体责任探析

An Analysis of the Main Liability of Urban Customized Commercial Medical Insurance Based on Multiple Perspectives of Welfare

近年来,我国医疗保障体系不断完善,基本医疗保险、大病保险、医疗救助等制度相互配合和补充,有效减轻了人民群众的医疗负担。为进一步保障重大疾病和多元医疗需求,同时区别于各个城市的生活情况与疾病特点,为促进各类医疗保险之间有效衔接,具有社商融合型普惠性质的城市定制型商业补充医疗保险(各地也称“惠民保”)应运而生,2020年以井喷之势迅速发展。在福利多元主义理论视域下“沪惠保”主体责任构建现状,发现其主体责任存在模糊性。研究“惠民保”的主体责任,目的在于通过研究各主体责任对定制商业医疗保险运行的影响程度,找出有效解决方案,为促进定制型商业医疗保险的发展提供参考。研究以“惠民保”为研究对象,运用德尔菲法和AHP层次分析法构建定制商业医疗保险运行影响因素的层次结构模型,量化出影响因素之间的比重,同时运用商业保险和社会保险互助理论以及政府职能转变理论进行分析,为促进各地定制医疗险进一步发展提供理论参考。

In recent years, China’s medical security system has been continuously improved. Basic medical insurance, critical illness insurance, medical assistance and other systems cooperate and supplement each other, effectively reducing the medical burden of the people. In order to further protect major diseases and diversified medical needs, and at the same time distinguish from the living conditions and disease characteristics of various cities, in order to promote the effective connection between various types of medical insurance, urban customized commercial supplementary medical insurance (also known as “Huimin Insurance”) with the nature of social and commercial integration came into being, and developed rapidly in 2020. From the perspective of welfare pluralism theory, the current situation of the construction of the main responsibility of “Shanghai Huibao” finds that its main responsibility is ambiguous. The purpose of studying the main responsibility of “Huimin Insurance” is to find out the effective solution by studying the influence of each main responsibility on the operation of customized commercial medical insurance, and to provide reference for promoting the development of customized commercial medical insurance. The research takes “Huimin Insurance” as the research object, uses Delphi method and AHP analytic hierarchy process to construct a hierarchical structure model of the influ-encing factors of customized commercial medical insurance operation, and quantifies the proportion of influencing factors. At the same time, it uses commercial insurance and social insurance mutual assistance theory and government function transformation theory to analyze, so as to provide theoretical reference for promoting the further development of customized medical insurance in various places.