医改背景下商业保险与医疗机构合作模式初探

加快发展商业健康保险,是助力医药卫生体制改革的重要举措?南通市第一人民医院通过与专业健康信息咨询公司及保险公司合作,成为国内首个提供惠民健康险直付服务的三级甲等医院?商业健康保险与医疗机构合作的新模式,能更好地满足人们多层次的健康保障需求,降低政府基本医疗保障制度的运行成本,提高医疗保障水平?     

商业健康险“很苦恼”,怎么破?

正商业健康保险发展的路径还处在探索阶段。现在,很多商业保险公司纷纷涌入商业健康险,其实更多是为了卡位。商业保险需要盈利。因此,商业健康保险很苦恼,我的商业模式是什么?盈利点在哪里?商业健康保险最终的目的还是要落脚到盈利,这是市场经济的基本规律。商业健康险卡位布局现在很多保险公司都有所谓的健康保险,但在健康保险中业务量最大的是养老保险公司,而不是健康保险公司,主要是依赖团体险的优势。整体上     

热点

国务院鼓励发展多样化健康保险务近日,国务院发布《关于加快发展现代保险服务业的若干意见》,要求发展多样化健康保险服务,鼓励保险公司大力开发各类医疗、疾病保险和失能收入损失保险等商业健康保险产品,并与基本医疗保险相衔接.     

基于“三方四体”的健康保险系统运营的博弈分析

从商业健康保险相关理论入手,分析归纳各个主体行为。目的在于在此基础上建立博弈模型,重点对政府-健康保险公司和健康保险公司-健康服务提供者两个博弈模型进行分析;研究表明政府要介入到健康保险市场进行监管,主要是对健康保险公司进行监管;研究说明在整个市场中,健康保险公司和健康服务提供者的最佳选择就是合作,以达到"共赢";指出健康保险系统是一个有机整体,其正常有效运作管理要靠"三方四体"协同合作。     

进城务工人员政策性健康保险研究

在对我国进城务工人员医疗保险现状进行分析的基础上,指出进城务工人员社会医疗保险存在的三个主要问题,结合商业健康保险的优势,探讨在当前形势下,以商业健康保险的形式解决进城务工人员医疗保险,基本保险模式为政府主导、健康保险公司具体承保的政策性健康保险。     

商业健康保险与健康教育

商业健康保险是由商业保险机构承办,为弥补被保险人因疾病、意外伤害等原因所带来的风险的保险,是社会健康保障不可缺少的一部分。它不同于社会医疗保险,社会医疗保险由政府开办,提供最基本健康保障不具盈利性。而商业健康保险由金融机构领导,保险公司具体承办,具有盈利性质。当前,我国正进行医疗制度改革,目的是要建立社会、合作、商业健康保险共同支撑的社会健康保障体系。商业健康保险与社会健康保险、合作医疗保险全面衔接,把社会医疗保险、合作医疗未覆盖的人群覆盖起来,把社会健康保险、合作医疗保险除外的大部分检查、治疗、服务、用…     

社区卫生服务与商业医疗保险合作初探

目前,我国居民对健康保险投保率比较低,即使是保险业相对发达的广州,该险种投保率也只有10%左右.究其原因,除了保险品种少、方式单一、保险程度低、居民保险意识不强等因素外,主要是在费用控制上缺乏一种有效的制约机制,即在投保人与保险公司之间缺乏一个可以信赖的中间介质--医疗机构.本文试图让社区卫生服务机构充当这一角色,以维护和促进投保者的健康为目标,建立一种投保人、保险公司和医疗机构三方的良好关系和运行机制,实现"利益捆绑",达到"三赢".     

广西城乡居民大病保险发展研究——基于SWOT分析

通过SWOT分析发现,广西城乡大病保险发展的优势包括政策优势、经济优势、地理优势;劣势包括起付线设置不合理、筹资渠道相对有限,统筹层次低、缺乏统一的大病医保信息平台、保险公司缺乏与医疗机构和政府医保部门的深层次合作;机会包括健康保险市场前景广阔、老龄化为健康保险提供的发展机遇;威胁包括医疗行为及费用管控存在道德风险、保险公司同行竞争带来的影响。提出了强化政府责任与筹资渠道的多元化、加快建设大病保险配套信息平台、政府和保险公司双方加强对医疗服务供需方的管控、拓展经办机构专业素质与队伍建设、探索城乡居民医疗保障一体化管理模式等建议。     

对商业健康保险与社会医疗保险衔接的探讨

通过系统研究和描述商业健康保险、社会医疗保险的发展现状，论述建立商业健康保险与社会医疗保险衔接机制的必要性，剖析目前存在的问题，并结合新“医改”政策，从提高健康保险公司专业化程度及产品创新等方面提出建立合理衔接机制的政策建议。     

多层次医疗保障体系视角下普惠型商业健康补充保险发展路径分析

目的:探究在多层次医疗保障体系视角下,提出优化我国普惠型商业健康补充保险发展路径的措施.方法:通过分析我国普惠型商业健康补充保险发展情况,梳理其产品、保险公司以及第三方管理平台情况;并基于典型地区的实践经验,剖析现存的问题.结果:目前我国普惠型商业健康补充保险正处于"井喷式"发展阶段,然而发展路径尚未成熟,仍旧存在产品...     

浅析我国商业健康保险对社会医疗保险的补充作用

社会医疗保险和商业健康保险共同构成了我国的医疗保障体系,其中社会医疗保险是基础,商业健康保险是必要补充。目前,我国商业健康保险业务量小,覆盖率低,对医疗费用的分担少,因此其对社会医疗保险补充作用的发挥程度较低,这是由医疗保险所针对风险的特殊性所决定的。为了充分发挥商业健康保险对社会医疗保险的补充作用,必须加强政商合作,实行专业化经营,加强人才培养,构建有吸引力的医保合作框架,针对特殊风险进行业务创新等。     

Medical care use and selection in a social health insurance with an equalization fund: evidence from Colombia

This paper studies the relationship between health status and insurance participation, and between insurance status and medical use in the context of a social health insurance with an equalization fund (SHIEF). Under this system, revenues from a mandatory payroll tax are collected into a single pool (equalization fund) that reimburses for-profit insurance companies according to a capitated formula. Although competition should induce insurers to control costs without reducing the quality of service necessary to attract consumers, limitations in the capitation formula might induce insurers to select against bad risks, and limitations in the contribution system might induce more healthy individuals to evade enrollment. A three-equation model having social health insurance, private health insurance, and using medical services is estimated using a 1997 Colombian household survey. Consistent with similar studies, participation in SHIEF increases medical care use. On the other hand, the evidence on selection is somewhat mixed: individuals who report good health status are more likely to participate in SHIEF, while those without a chronic condition are less likely to participate in SHIEF.     

我国商业健康保险发展影响因素实证分析

近年来我国商业健康保险市场发展迅速,但其总体水平与我国庞大的人口规模和高额的医疗费用支出相比还存在很大差距。本文首先分析了商业健康保险供给与需求的影响因素,然后从实证分析的角度出发,运用计量经济学方法和EVIEWS软件对近几年的健康保险相关数据进行了回归分析。1998—2009年的数据分析结果显示:我国城镇居民人均可支配收入和保险意识的提高显著地促进了商业健康保险的发展,短期内社会医疗保障水平的提高与商业健康保险的发展呈负相关,人均医疗卫生费用、老年人口比重及城镇人口数量对商业健康保险的发展无明显影响。     

Pricing behaviour of nonprofit insurers in a weakly competitive social health insurance market

In this paper we examine the pricing behaviour of nonprofit health insurers in the Dutch social health insurance market. Since for-profit insurers were not allowed in this market, potential spillover effects from the presence of for-profit insurers on the behaviour of nonprofit insurers were absent. Using a panel data set for all health insurers operating in the Dutch social health insurance market over the period 1996-2004, we estimate a premium model to determine which factors explain the price setting behaviour of nonprofit health insurers. We find that financial stability rather than profit maximisation offers the best explanation for health plan pricing behaviour. In the presence of weak price competition, health insurers did not set premiums to maximize profits. Nevertheless, our findings suggest that regulations on financial reserves are needed to restrict premiums.     

Reforming health insurance in Argentina and Chile

The paper examines the recent reforms of health insurance in Chile and Argentina. These partially replace social health insurance with individual insurance administered through the private sector. In Chile, reforms in the early 1980s allowed private health insurance funds to compete for affiliates with the social health insurance system. In Argentina, reforms in the 1990s aim to open up the union-administered social insurance system to competition both internally and from private insurers. The paper outlines the specific articulation of social and individual health insurance produced by these reforms, and discusses the implications for health insurance coverage, inequalities in access to healthcare, and health expenditures.     

Spillover effects of supplementary on basic health insurance: evidence from the Netherlands

Like many other countries, the Netherlands has a health insurance system that combines mandatory basic insurance with voluntary supplementary insurance. Both types of insurance are founded on different principles. Since basic and supplementary insurance are sold by the same health insurers, both markets may interact. This paper examines to what extent basic and supplementary insurance are linked to each other and whether these links generate spillover effects of supplementary on basic insurance. Our analysis is based on an investigation into supplementary health insurance contracts, underwriting procedures and annual surveys among 1,700–2,100 respondents over the period 2006–2009. We find that health insurers increasingly use a variety of strategies to enforce a joint purchase of basic and supplementary health insurance. Despite incentives for health insurers to use supplementary insurance as a tool for risk selection in basic insurance, we find limited evidence of supplementary insurance being used this way. Only a minority of health insurers uses health questionnaires when people apply for supplementary coverage. Nevertheless, we find that an increasing proportion of high-risk individuals believe that insurers would not be willing to offer them another supplementary insurance contract. We discuss several strategies to prevent or to counteract the observed negative spillover effects of supplementary insurance.     

Bonus systems in health insurance: a microeconomic analysis.

Faced with the cost explosion in the health care sector, policy-makers in most industrialized countries have been focusing on cost-sharing in health insurance as a possible solution. This is a sanction meted out to users of medical care; the alternative of creating positive incentives for non-users has not yet received nearly as much attention. This paper reports on the experiences made by German private health insurers with their plans offering rebates as well as experience-rated bonuses for no claims. It is argued that a rebate offer may be at least as attractive as conventional cost-sharing plans from the point of view of the consumer since these new options allow him to choose the time at which he is to bear the financial consequences of an illness. In the second part of the paper, predictions are derived concerning the incentives contained in the policies written by three particular insurers. Clear evidence of a decrease in demand for ambulatory medical care at the lower end of the billings distribution is found in rebate and bonus plans. The concluding section of the paper contains a discussion of the results with a view on the continuing debate about the reform of social health insurance.     

商业健康保险对居民健康的影响——来自CGSS数据的经验证据

商业健康保险作为社会医疗保险的有益补充,是推动健康中国战略的重要抓手。本文基于中国综合社会调查(CGSS)数据,采用截面倍差法(DID)与倾向得分匹配法(PSM)估计了商业健康保险对参保居民健康的影响。研究发现:商业健康保险具有正向健康效应,即参加商业健康保险能够显著促进居民健康,提升居民健康水平。通过使用截面倍差法克服因果效应与倾向得分匹配法进行反事实估计发现,商业健康保险对居民健康的正向影响仍然成立。扩展性分析显示,商业健康保险对高收入群体的健康促进效应显著高于低收入群体,同时在40岁以上、中西部地区更显著。本文结论有助于认清商业健康保险对提升居民健康水平的价值与深层影响。     

对我国医疗保险专业高等教育发展的思考

我国医疗保险专业是在社会医疗保险改革的背景下诞生的.随着社会医疗保险改革的深化及商业健康保险的发展,医疗保险专业高等教育得到了进一步的发展;反之,近年社会医疗保险和商业健康保险的快速发展也得益于医疗保险专业高等教育的进步.然而,在新形势下,医疗保险专业高等教育与社会需求严重脱节,造成就业率下降、大量专业学生流失到其他领城.为解决这一突出矛盾,相关各高校应明确专业发展方向、强化学生实践能力培养、提高社会认同度,从而促进医疗保险专业高等教育与社会协调发展.     

荷兰健康保险制度改革经验及启示

文章对荷兰健康保险制度改革的历史过程以及现状进行描述分析,总结荷兰健康保险制度改革的特点：建立基于管理型竞争的强制性私立健康保险;私立保险方竞争获得更多的参保人员;政府对保险方和提供者的行为进行监管并提供相关信息;建立了风险均等化制度,消除不同保险方的风险差异。荷兰健康保险制度改革为我国健康保险制度进一步完善提供一些借鉴：消除不同健康保险制度的差距,保障一致性;建立风险均等化制度,调整不同基金池间的风险;商业保险机构参与经办健康保险管理服务;加强医保第三方对供方行为的制约和监督。