[1]胡杨木,刘 敬,钟碧霞,等.普惠型商业医疗保险的保障效果研究[J].卫生经济研究,2024,41(02):27-30.
　HU Yangmu,LIU Jing,ZHONG Bixia,et al.Study on the Protection Effect of Inclusive Commercial Medical Insurance[J].Journal Press of Health Economics Research,2024,41(02):27-30.
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普惠型商业医疗保险的保障效果研究
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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:
27-30
栏目:
医疗保障
出版日期:
2024-01-30

文章信息/Info

Title:
Study on the Protection Effect of Inclusive Commercial Medical Insurance
作者:
胡杨木1; 刘 敬2; 钟碧霞2; 李 璐1; 范阳东1
1.广州医科大学卫生管理学院，广东 广州 511436
2.广州市第一人民医院，广东 广州 510180
Author(s):
HU Yangmu;  LIU Jing;  ZHONG Bixia;  LI Lu;  FAN Yangdong
School of Health Management, Guangzhou Medical University, Guangzhou Guangdong 511436, China
关键词:
惠民保; 保障效果; 多层次医疗保障
Keywords:
inclusive commercial medical insurance;  protection effect;  multi-level medical security
分类号:
F840.684
文献标志码:
A
摘要:
目的：分析惠民保对减轻高额医疗费用患者经济负担的作用。方法：采用描述性统计，分析不同层次医疗保险的实际报销情况；利用相关性分析法和多元线性回归方法，分析惠民保对医保目录外费用和封顶线以上费用的保障效果。结果：惠民保对居民医保和职工医保参保患者的平均报销比例为10.85%和8.43%；报销金额与住院天数、超限额金额、丙类项目金额和乙类项目自付金额显著正相关，基本实现了政策目标。建议：完善顶层设计，使多层次医保体系惠及更多参保人；持续推动产品创新，积极向以健康为中心转变；进一步优化报销政策，实现惠民保高质量发展。
Abstract:
Objective To analyze the effect of inclusive commercial medical insurance on reducing the financial burden of patients with high medical expenses. Methods The actual reimbursement of different levels of medical insurance was analyzed by the descriptive statistics. The effect of inclusive commercial medical insurance on the protection of expenses outside National Reimbursement Drug List and the expenses above the cap line was analyzed by correlation analysis and multiple linear regression methods. Results The average reimbursement ratios of inclusive commercial medical insurance for resident and employee basic medical insurance participants were 10.85% and 8.43%. The reimbursement amount was significantly and positively correlated with the number of hospitalization days, the amount of over-limit, the amount of category C items and the amount of out-of-pocket payment for category B items, which basically achieved the policy objectives. Conclusion It is necessary to improve the top-level design to enable the multi-level medical insurance system to benefit more insured people, continue to promote product innovation and actively shift to health-centered, and further optimize the reimbursement policy to achieve the high-quality development of inclusive commercial medical insurance.

参考文献/References:

[1] 郑功成，赵明月.面向未来的高质量医疗保障制度建设[J].中共中央党校（国家行政学院）学报，2022，26（06）：108-117.
[2] 曹如霞.多层次医疗保障视角下“惠民保”的属性分析[J].保险职业学院学报，2021，35（05）：18-23.
[3] 朱铭来，仝洋，周佳卉，等.多层次医疗保障体系评估——基于复合维度的发展指数测算[J].保险研究，2022（10）：3-18.
[4] 郑秉文.惠民保的政策红利与制度创新[J].中国卫生，2021（09）：29-31.
[5] 胡善联.惠民保需要更多成长的时间[J].中国卫生，2021（09）：34-35.
[6] 许荣庭，沈袁恒.普惠型医疗保险发展：实践困境与优化方向[J].西南金融，2022（01）：40-51.
[7] 王欣，陈文，张璐莹.多层次保障体系下普惠型商业医疗保险的作用研究[J].中国卫生经济，2023，42（03）：10-13.
[8] 于保荣，贾宇飞，孔维政，等.中国普惠式健康险的现状及未来发展建议[J].卫生经济研究，2021，38（04）：3-8.
[9] 周钦，田森，潘杰.均等下的不公——城镇居民基本医疗保险受益公平性的理论与实证研究[J].经济研究，2016，51（06）：172-185.
[10] 李亚青.医疗保障对健康平等的影响机制和精准化改进路径[J].社会保障评论，2022，6（02）：59-73.
[11] 王贞，封进.长期护理保险对医疗费用的替代效应及不同补偿模式的比较[J].经济学（季刊），2021，21（02）：557-576.
[12] 朱凤梅.医保预付制改革的效果研究——来自中国CHIRA数据的实证检验[J].保险研究，2021（03）：112-127.
[13] 苏泽瑞.普惠性商业健康保险：现状、问题与发展建议[J].行政管理改革，2021（11）：90-99.
[14] 张璐莹，陈文.我国普惠型商业医疗保险亟待治理创新[J].中国卫生资源，2021，24（05）：492-494.
[15] 《“惠民保”发展模式研究》课题组，金小桃，王琴，等.“惠民保”发展模式研究[J].保险研究，2022（01）：3-20.
[16] 于保荣，王庆.中国惠民保产品的性质、利益相关方与发展趋势[J].卫生经济研究，2023，40（04）：15-18.
[17] 冯鹏程，朱俊生.促进普惠补充医保可持续发展[J].清华金融评论，2021（07）：87-90.

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[10]李玉华.普惠性商业医疗保险的实践及路径优化研究[J].卫生经济研究,2024,41(10):20.
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更新日期/Last Update: 2024-01-30