[1]朱佳英,王平洋,高奇隆.惠民型商业补充医疗保险减轻疾病经济负担的路径及效果分析 ——以浙江省为例[J].卫生经济研究,2025,42(07):36-41.
　ZHU Jiaying,WANG Pingyang,GAO Qilong.Study on the Path and Effect of Huimin Commercial Supplementary Medical Insurance in Reducing the Economic Burden of Disease ——Taking Zhejiang Province as an Example[J].Journal Press of Health Economics Research,2025,42(07):36-41.
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惠民型商业补充医疗保险减轻疾病经济负担的路径及效果分析
——以浙江省为例

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
42
期数:
2025年07期
页码:
36-41
栏目:
医疗保障
出版日期:
2025-07-01

文章信息/Info

Title:
Study on the Path and Effect of Huimin Commercial Supplementary Medical Insurance in Reducing the Economic Burden of Disease
——Taking Zhejiang Province as an Example
作者:
朱佳英1; 王平洋2; 高奇隆1
1.浙江省人民医院（附属人民医院），杭州医学院，浙江 杭州 310014
2.浙江省医疗保障研究会，浙江 杭州 310043
Author(s):
ZHU Jiaying;  WANG Pingyang;  GAO Qilong
Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou Zhejiang 310014, China
关键词:
多层次医疗保障体系; 商业健康险; 疾病经济负担
Keywords:
multi-level medical security system;  commercial health insurance;  economic burden of disease
分类号:
F840.684
文献标志码:
A
摘要:
目的：解析惠民型商业补充医疗保险的运行机理、减负路径及政策效果，为完善我国多层次医疗保障体系提供参考。方法：基于浙江省“惠民保”运营数据，选取参保率、续保率、赔付率、人均赔付额等指标，采用描述性统计分析“惠民保”减轻疾病经济负担的效果。结果：浙江省各地市“惠民保”参保对象主要为基本医疗保险参保人，缴费标准每人每年50~300元，保障内容可分为医保类费用追加保障、非医保类费用补充保障与特定药品或医疗服务项目单列保障，起付线为0~2.2万元，给付比例为5%~95%，主要受益群体是居民医保参保人群和高龄参保人群。结论：惠民保基于“政府指导—市场运作”模式，有效减轻了参保人疾病经济负担，但同时面临普惠性质与保障能力矛盾加剧、投保人权利义务不对等、可持续经营风险日益凸显等挑战，需进一步完善相关机制实现长效发展。
Abstract:
Objective To analyze the operation mechanism, path of reducing the burden, and the effect of the policy of Huimin commercial supplemental medical insurance, and so to provide references for the improvement of multi-level medical security system. Methods Based on the operational data of "Huimin Insurance" in Zhejiang Province, the effect of "Huimin Insurance" in reducing the economic burden of diseases was analyzed by descriptive statistics, selecting the indicators of participation rate, renewal rate, claim rate and per capita claim amount. Results In general, "Huimin Insurance" in various regions in Zhejiang Province mainly covered basic medical insurance participants, with a contribution standard of ranging from 50 yuan to 300 yuan per person per year. The coverage content could be divided into additional coverage for medical insurance-related expenses, supplementary coverage for non-medical insurance-related expenses, and separate coverage for specific medicines or medical service items. The deductible ranged from 0 to 22000 yuan, with a reimbursement ratio of 5% to 95%. The main beneficiaries of "Huimin Insurance" were the residents' medical insurance participants and the senior insurance participants. Conclusion Based on the model of "government guidance - market operation", "Huimin Insurance" effectively reduces the economic burden of disease of the insured. However, it faces challenges such as conflicts between the nature of universal coverage and protection capacity, unequal rights and obligations of the insured, and the increasingly prominent risk of sustainable operation. It is necessary to further improve the relevant mechanism to realize long-term development.

参考文献/References:

[1] 《“健康中国2030”规划纲要》[EB/OL].（2016-10-25）.https://www.gov.cn/zhengce/202203/content_3635233.htm.
[2] 决胜全面建成小康社会 夺取新时代中国特色社会主义伟大胜利[EB/OL].（2017-10-18）.https://www.spp.gov.cn/tt/201710/t2017 1018_202773.shtml.
[3] 高举中国特色社会主义伟大旗帜 为全面建设社会主义现代化国家而团结奋斗[EB/OL].（2022-10-25）.https://www.gov.cn/xinwen/ 2022-10/25/content_5721685.htm.
[4] 李岩，张毓辉，万泉,等.我国卫生总费用回顾与展望[J].中国卫生经济，2022，41（06）：9-11,18.
[5] 贾宇飞，于保荣.商业健康保险在医药费用支付中的作用及国际经验[J].卫生经济研究，2020，37（05）：8-12.
[6] 房鑫，郝艳华，吴群红，等.基于Delphi法的完善全民医保制度要素设计专家意见分析[J].中国卫生经济，2016，35（02）：29-31.
[7] 余鸣人，陈昊，徐娟.我国省级普惠式健康险发展现状[J].中国卫生资源，2022，25（02）：217-222，229.
[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] 黄薇，张岚，郑小华，等.新形势下商业健康保险产品开发思路与策略[J].卫生经济研究，2021，38（02）：26-29,34.
[10] 王平洋.集成创新改革促进惠民保可持续发展——以浙江惠民保为例[J].保险理论与实践，2024（11）：91-116.

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更新日期/Last Update: 2025-07-01