[1]李骄阳,张璐莹,齐怡嘉,等.美国医疗保险优势计划的经验及启示 ——基于公私合作视角[J].卫生经济研究,2024,41(12):72-75.
　LI Jiaoyang,ZHANG Luying,QI Yijia,et al.The Experience and Implications of the Medicare Advantage Plans of the United States ——From the Perspective of Public-Private Partnerships[J].Journal Press of Health Economics Research,2024,41(12):72-75.
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美国医疗保险优势计划的经验及启示
——基于公私合作视角
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
41
期数:
2024年12期
页码:
72-75
栏目:
他山之石
出版日期:
2024-12-03

文章信息/Info

Title:
The Experience and Implications of the Medicare Advantage Plans of the United States
——From the Perspective of Public-Private Partnerships
作者:
李骄阳1; 张璐莹1; 齐怡嘉1; 冯逸佳1
1.复旦大学公共卫生学院， 上海 200032
Author(s):
LI Jiaoyang;  ZHANG Luying;  QI Yijia;  FENG Yijia
School of Public Health, Fudan University, Shanghai 200032, China
关键词:
医疗保险优势计划; 公私合作; 基本医疗保险; 商业医疗保险
Keywords:
Medicare Advantage Plans;  public-private partnerships;  basic medical insurance;  commercial medical insurance
分类号:
F840.684
文献标志码:
A
摘要:
目的：借鉴美国医疗保险优势计划中政府与商业保险公司合作经验，探索我国普惠型商业医疗保险的发展路径。方法：采用文献研究法，系统总结美国医疗保险优势计划的主要特点。结果：美国医疗保险优势计划由政府与商业保险公司协同运行，具有权责清晰、共同筹资、合作支付、保障范围与公共医疗保险紧密衔接、监督管理严格的特点，可以为我国普惠型商业医疗保险发展提供借鉴。结论：我国在推动普惠型商业医疗保险发展时，应对保险方案给予政策指导，鼓励商业保险公司在衔接基本医保的基础上优化保险方案，同时强化对商业保险公司运营的监管，不断完善评价公示机制。
Abstract:
Objective To utilize insights from the Medicare Advantage Plans of the United States characterized by a collaborative effort between the government and commercial insurance entities, and to explore effective strategies for integrating inclusive commercial medical insurance in China. Methods Based on the literature review, the main characteristics of the Medicare Advantage Plans in the United States were systematically summarized. Results The Medicare Advantage plan was administered through a partnership between the government and commercial insurance companies, characterized by clear powers and responsibilities, co-financing and cooperative payments, coverage closely with public health insurance, and stringent supervision and management, which could provide a reference for the development of inclusive commercial medical insurance in China. Conclusion China should offer policy guidance to commercial medical insurance programs to enhance the effective integration of inclusive commercial medical insurance. The insurance companies should be encouraged to optimize their insurance programs based on convergence with basic medical insurance. Additionally, the government should strengthen the supervision of insurance company operations by conducting regular evaluations and communicating the results to the public.

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相似文献/References:

[1]封欣蔚,杨小丽,杨 咪,等.PPP模式在我国医疗领域的应用现状[J].卫生经济研究,2017,(02):14.
[2]刘玉娟.医疗保险公私合作的困境与出路[J].卫生经济研究,2021,38(2):22.
　LIU Yu-juan.Dilemma and Way of Public-Private Cooperation in Medical Insurance[J].Journal Press of Health Economics Research,2021,38(12):22.

更新日期/Last Update: 2024-12-03