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国家责任转变中普惠型商业医疗保险的公私合作模式研究

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普惠型商业医疗保险作为多层次医疗保障体系中的重要一环,其可持续发展的关键在于如何融入多元性、开放性及协同性的公私合作交互关系中。我国现有国家管制责任下的政府指导模式、国家给付责任下的政府主导模式及国家服务责任下的政府推动模式,暴露出规范主义下普惠与商业法益保护的失衡、功能主义下公私协同保险参与治理的失效以及保险权责界限模糊导致公私法监管混乱的问题。在国家责任转变视野下,国家担保责任作为公私合作领域的新兴国家责任理论,对于解决普惠型商业医疗保险领域的公私合作难题,有着天然的理论优势。在国家担保责任理论下,普惠型商业医疗保险的公私合作模式建立在公私角色定位的基本立场上,依托公私共治方式之转型为路径,以公私权责之合理配置强化法律保障,实现"普惠"和"商业"的融合共生。
A Study on Public-Private Partnership Model for Inclusive Commercial Medical Insurance in the State Responsibility Transformation
Inclusive commercial medical insurance,as a vital component of the multi-tiered medical security system,hinges on in-tegrating into diverse,open,and collaborative public-private partnership(PPP)interactions for its sustainable development.Exist-ing models in China,including the government-guided model under national regulatory responsibility,the government-led model under national payment responsibility,and the government-promoted model under national service responsibility,have exposed is-sues such as an imbalance between inclusiveness and commercial legal interest protection under normativism,failures in public-private collaborative insurance governance under functionalism,and confusion in public-private law regulation due to ambiguous boundaries of insurance rights and responsibilities.From the perspective of the transformation of state responsibility,the state guar-antee responsibility,as an emerging theory of state responsibility in the field of PPP,naturally possesses theoretical advantages for addressing PPP challenges in inclusive commercial medical insurance.Under this theory,PPP in inclusive commercial medical in-surance is built on the fundamental stance of defining public and private roles,relying on the transformation of public-private co-governance as the path,and strengthening legal safeguards through the rational allocation of public and private rights and responsi-bilities to achieve the symbiotic integration of"inclusiveness"and"commerciality."

transforming state responsibilityinclusive commercial medical insurancepublic-private partnershipnational guar-antee responsibilitysocial governance

康雷闪、雷祖发

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中国石油大学(华东)文法学院

国家责任转变 普惠型商业医疗保险 公私合作 国家担保责任 社会治理

2024

保险研究
中国保险学会

保险研究

CSSCICHSSCD北大核心
影响因子:1.072
ISSN:1004-3306
年,卷(期):2024.(12)