双层医疗保障体系的运行及风险应对策略——来自智利的证据和经验

智利拥有公共和私人主体共同参与的医疗服务与医疗保障体系,且因政策上歧视高健康风险人群购买私人医疗保险曾引发逆向选择问题。本文梳理了智利私人医疗保险的发展及其双层医疗保障体系的运行逻辑,通过重点分析智利健康保证计划(GES)改革框架,结果发现,限制患者自付费用的比例、免费提供高成本的治疗药物是减少因社会经济地位导致的健康不公平的有效措施,其成功经验在于平衡了公共和私人医疗保险的发展关系,同时有法律和良好的政策工具规范私人医疗保险市场运行。以智利经验为启发,建议提高商业保险在我国医疗保障体系中的参与度,统一商业保险参与医疗保障事务经办的规范,同时促进商业健康保险与基本医疗保险良好协同。

Operation and risk response strategies of the dual medical security system: Evidence and experience from Chile

Chile has a mixed health system where public and private actors are engaged in the healthcare and insurance provision. It was found that private system tends to discriminate against people with higherhealth risk; therefore, due to this policy discrimination against high-risk population, the purchase of private medical insurance has led to adverse selection. This paper analyzes the development of Chile''s private medical insurance and the operating logic of its dualmedical security system. By analyzing the GES reform framework in Chile, it was found that limiting the proportion of patients'' out-of-pocket expenses and providing high-cost medicines for free constitute effective measures to reduce health inequities caused by people''s socio-economic status. Its successful experience lies in balancing the development relationship between public and private healthcare and medical insurance, while simultaneously promulgating laws and policy tools to regulate the operation of private medical insurance market. Taking reference on Chile''s experience, it is suggested that China should improve the participation of commercial insurance in China''s medical security system, unify the rules for commercial insurance participation in healthcare affairs, and promote good coordination between private and basic medical insurance.