新医改环境下我国商业健康保险发展的现状、问题与对策

摘要

在我国,商业健康保险与基本医疗保险、补充医疗保险、医疗救助共同构成了覆盖城乡居民的多层次医疗保障体系.经过近三十年的发展,我国商业健康保险在市场覆盖、保费收入、赔付支出、风险控制、行业监管等方面取得了一定进展.但是,商业健康保险发展过程中也面临着医疗保障作用发挥不够充分、专业化水平不高、风险控制能力薄弱等问题.本文在阐述我国商业健康保险发展现状和问题的基础上,提出其发展策略:一是拓展业务领域,充分发挥商业健康保险的作用；二是构建组织和经营体系,提高专业化经营水平；三是多措并举,加强风险控制能力；四是以承办城乡居民大病保险为契机,转变发展模式.%In China,a multi-level medical security system covers both urban and rural residents and includes commercial health insurance,primary medical insurances,other supplementary medical insurances and assistance.After nearly three decades,commercial health insurance has progressed in terms of market coverage,premiums,claims paid,risk control,and industry regulation.However,commercial health insurance also has some problems,including the insufficient role of health insurance,lack of professionalism,and weak risk control.In this article,we propose strategies for developing commercial health insurance.First,we suggest expanding business areas to give full play to the role of commercial health insurance.Second,we suggest setting up an organizational and operating system to improve the level of professional management.Third,we suggest exploring a variety of practices to strengthen risk control ability.Fourth,we suggest establishing catastrophic health care coverage for urban and rural residents.