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惠民保可持续发展研究

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在多层次医疗保障体系建设中,惠民保是连接基本医疗保险与商业健康保险的中间层,是化解重大疾病风险、推进共同富裕的一项保障.本文探讨惠民保在多层次医疗保障体系中的地位,分析其参保、赔付以及产品现状,总结惠民保面临参保率不足、参保人群结构不良、赔付率不稳定且赔付不均等问题.基于此,本文提出实行基于DRG/DIP按病组支付的惠民保发展模式,旨在不影响相关主体利益的基础上改善参保率,优化参保结构,增强参保人获得感,从而吸引健康人群投保,提升制度普惠性和可持续性,为完善多层次医疗保障体系建设做出贡献.
A Research on the Sustainable Development of City-Customized Medical Insurance
In the construction of multi-level medical security system,city-customized medical insurance(hereinafter referred to as Huiminbao)is the middle layer connecting basic medical insurance and commercial insurance,which is a guarantee to resolve the risk of major diseases and promote common prosperity.This article clarifies the position of Huiminbao in the multi-level medical security system,analyzes the status of Huiminbao's participation rate,compensation rate and products,summarizes the problems such as insufficient insurance participation rate,poor structure of the insured population,unstable compensation rate and unequal compensation.This article proposes the model of paying according to the disease group based on DRG/DIP,which helps improve the insurance participation rate,optimize the structure of insurance participation and enhance the sense of acquisition of the insured on the basis of not affecting the interests of the relevant subjects.In addition,it also helps to attract healthy people to insure,effectively improve the inclusiveness and sustainability of the system,and make contribution to the construction of multi-level medical security system.

city-customized medical insuranceinclusive insurancesustainable developmentpayment according to the disease group

孙洁、黄艺飞、罗屿浪、李博轩、毕博

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对外经济贸易大学 北京 100029

国新健康保障服务集团股份有限公司 北京 100028

惠民保 普惠保险 可持续发展 按病组付费

北京社科重点课题

19GLA008

2024

中国医疗保险
中国医疗保险研究会

中国医疗保险

影响因子:0.492
ISSN:1674-3830
年,卷(期):2024.(1)
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