[1]谭清立,丘丽莹.城市普惠型商业医疗保险比较研究[J].卫生经济研究,2024,41(02):23-26,30.
　TAN Qingli,QIU Liying.Comparative Study on Urban Inclusive Commercial Medical Insurance[J].Journal Press of Health Economics Research,2024,41(02):23-26,30.
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城市普惠型商业医疗保险比较研究
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
41
期数:
2024年02期
页码:
23-26,30
栏目:
医疗保障
出版日期:
2024-01-30

文章信息/Info

Title:
Comparative Study on Urban Inclusive Commercial Medical Insurance
作者:
谭清立1; 丘丽莹1
1.广东药科大学医药商学院，广东 中山 528453
Author(s):
TAN Qingli;  QIU Liying
School of Pharmaceutical Business, Guangdong Pharmaceutical University, Zhongshan Guangdong 528453, China
关键词:
普惠型商业医疗保险; 参保率; 罕见病; 医保目录
Keywords:
inclusive commercial medical insurance;  insurance coverage;  rare disease;  medical insurance reimbursement list
分类号:
F840.684
文献标志码:
A
摘要:
目的：分析城市普惠型商业医疗保险的保障情况，为完善我国多层次医疗保障体系提供参考。方法：基于118款城市普惠型商业医疗保险产品，对政府参与度、产品定价和报销情况等进行全面分析；选取部分产品从赔付情况、参保率、既往症设定和罕见病保障情况等方面进行对比分析。结果：城市普惠型商业医疗保险产品数据披露不够透明，“补充”保障作用尚未充分发挥，对特殊群体的保障不到位，可持续经营能力存疑。结论：发挥政府作用，完善运营和监督机制；优化产品设计，提高保障水平；控制运行风险，延伸服务链条。
Abstract:
Objective To analyze the security situation of urban inclusive commercial medical insurance, and to provide reference for improving multi-level medical system in China. Methods Based on 118 urban inclusive commercial medical insurance products, a comprehensive analysis was conducted on government participation, product pricing, and reimbursement situation. Based on partially selected products, a comparative analysis was conducted, including compensation situation, insurance coverage, past disease setting, and rare disease security. Results The data disclosure of urban inclusive commercial medical insurance products was not transparent enough. The role of supplementary security was not fully utilized. The security for special groups was not in place, and the sustainable operation ability was questionable. Conclusion It is necessary to leverage the role of the government to improve operation and supervision mechanisms, optimize product design to improve security level, weaken operation risks and extend service chains.

参考文献/References:

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相似文献/References:

[1]黄显官,王 敏,罗元鹏,等.关于完善大学生医保政策的研究[J].卫生经济研究,2016,(10):34.
[2]陈 星,张璐莹,俞纯璐,等.普惠型商业医疗保险的可持续性及影响因素研究[J].卫生经济研究,2025,42(04):5.
　CHEN Xing,ZHANG Luying,YU Chunlu,et al.Study on the Sustainability and Influencing Factors of Inclusive Voluntary Health Insurance[J].Journal Press of Health Economics Research,2025,42(02):5.

更新日期/Last Update: 2024-01-30