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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:

43

期数:

2026年05期

页码:

59-62

栏目:

医疗保障

出版日期:

2026-04-24

文章信息/Info

Title:

Experience and Implications of Achieving High Coverage in Australia's Private Health Insurance

作者:

韩 璐¹; 刘跃华¹; 贾茹旭¹; 陈 诺¹; 穆永亮¹; 王 健¹

1.武汉大学董辅礽经济社会发展研究院，湖北 武汉 430072

Author(s):

HAN Lu;  LIU Yuehua;  JIA Ruxu;  CHEN Nuo;  MU Yongliang;  WANG Jian

Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan Hubei 430072, China

关键词:

多层次医疗保障体系; 商业健康保险; 澳大利亚

Keywords:

multi-level medical security system;  private health insurance;  Australia

分类号:

R19

文献标志码:

A

摘要:

目的：总结澳大利亚商业健康保险实现高参保率的经验，为完善我国多层次医疗保障体系提供参考。方法:梳理澳大利亚商业健康保险的制度背景、运营模式及风险分摊机制，提出对我国的启示建议。结果：澳大利亚商业健康保险通过产品分级分类，为居民提供灵活多样的医疗保障选择；通过风险均衡池机制和终身健康保险等政策工具，实现风险共济和参保激励。结论:基于澳大利亚的实践经验，我国在完善多层次医疗保障体系中应加强立法与顶层设计，确保政策协同落地；优化商业健康保险参保结构，提升产品可持续性；建立多元风险分摊机制，推动风控体系转型。

Abstract:

Objective To summarize the experiences of achieving high coverage in Australia's private health insurance, and to provide references for improving multi-level medical security system in China. Methods The institutional background, operational models, and risk-sharing mechanisms of Australia's private health insurance system were systematically reviewed, and implications and recommendations for China were offered. Results Australia's private health insurance provided residents with flexible and diverse medical insurance options through product grading and classification. By policy tools such as risk-equalization pool and lifetime health insurance, risk pooling and enrollment incentives were effectively achieved. Conclusion Drawing on Australia's practical experience, China should strengthen legislation and top-level design in improving the multi-level medical security system to ensure coordinated implementation of policies, optimize the structure of private health insurance participation to enhance product sustainability, and establish a diversified risk sharing mechanism to promote the transformation of risk control system.

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更新日期/Last Update: 2026-04-24