| 引用本文: |
王欣,陈文,张璐莹.多层次保障体系下普惠型商业医疗保险的作用研究*[J].中国卫生经济,2023,42(3):10-13.[点击复制] |
WANG Xin,CHEN Wen,ZHANG Lu-ying.The Role of Inclusive Commercial Medical Insurances in Multi-layer Medical Security System[J].CHINESE HEALTH ECONOMICS,2023,42(3):10-13.[点击复制] |
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| 摘要: |
| 目的：对比典型地区多层次医疗保障体系下普惠型商业医疗保险的保障作用，为促进普惠型商保的健康发展、 构建更有效的多层次医疗保障体系提供参考。方法：以3个地区为代表开展案例研究，基于基本医疗保险和大病保险的报销政策和普惠型商业医疗保险方案，试算不同医疗费用水平下普惠型商业医疗保险的报销情况。结果：普惠型商保在发生高额医疗支出时发挥补充保障作用，保障作用与其方案设计和基本医疗保险及大病保险的特点紧密相关。结论：各地应结合基本医疗保险及大病保险的保障情况，因地制宜地设计普惠型商业医疗保险的责任范围和待遇水平，进一步发挥普惠型商业医疗保险的补充保障作用。 |
| 关键词: 基本医疗保险 大病保险 普惠型商业医疗保险 补充保障作用 案例研究 |
| DOI： |
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| 基金项目:国家社科基金重大项目(20ZDA072) |
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| The Role of Inclusive Commercial Medical Insurances in Multi-layer Medical Security System |
| WANG Xin,CHEN Wen,ZHANG Lu-ying |
| (School of Public Health,Fudan University,Shanghai 200032 ,China) |
| Abstract: |
| Objective: To analyze and compare the role of inclusive commercial medical insurances in the multi-layer medical security system of representative regions and provide references for promoting the development of inclusive commercial medical insurances as well as constructing more effective multi-layer medical security system. Methods: Three regions were selected to conduct case studies. Based on the schemes of local social medical insurances and inclusive commercial medical insurances，the reimbursement rates of the insurances at different medical cost levels were calculated. Results: Inclusive commercial medical insurances play a supplementary role when high medical expenditure is incurred，and the role is in relation to the schemes of inclusive commercial medical insurances and social medical insurances' features. Conclusion: To improve the supplementary role of inclusive commercial medical insurances，it is suggested to design the insurance coverage and treatment levels of inclusive commercial medical insurances appropriately coherent with the local social medical insurance benefits. |
| Key words: basic medical insurance inclusive commerial insurance inclusive commercial medical insurance supplementary role case study |
