福建省保险业开展补充医疗保险的探索.pdfVIP

福建省保险业开展补充医疗保险的探索 朱增镳 （中国保险监督管理委员会福建监管局，福建 福州 350003） ［摘要］保险业参与补充医疗保险，有利于社会保障体系的完善，有利于政府运用经济 手段加强社会管理，有利于群众保险意识的增强，有利于保险业自身的发展。当前，保险业 参与补充医疗保险存在的问题是，数据积累和共享机制尚未完全建立，政策多变或缺乏持续 性，医疗过程风险可控性偏低，部分公司经营行为缺乏理性。要进一步推动保险业参与补充 医疗保险，在参保人员方面应坚持应保尽保原则，在保险公司的选择上应坚持公开、公平、 公正原则，在保费、保额、起付线的确定上应坚持“三兼顾”原则；国家应加快出台补充医 疗保险的相关法律法规，加大对补充医疗保险的管理、制度创新与政策扶持力度；保险公司 应进一步强化自身建设，强化对参与补充医疗保险的认识，提升服务能力和服务水平。 ［关键词］补充医疗保险；社会保障；制度创新；政策扶持；风险防范 ［中图分类号］ F840.684 ［文献标识码］ A ［文章编号］1004-3306（2007）09-0076-03 Abstract： The insurance industry′s participation into the complementary medical insurance will promote perfection of the whole social security system, enhance the government′s social management function through economic means, uplift public awareness on insurance, and contribute to the development of the insurance industry itself. Currently, the major questions for doing so is that the data accumulation and sharing mechanism hasn′t been fully established, government policies are changed frequently without consistency, control of risks in the process of medical provision is difficult, and some insurers operate irrationally. To further reinforce insurer′s involvement in the complementary medical insurance, we should provide coverage to all eligible people, the insurers should stick to the principles of transparency, fair　dealing and justice and taking into consideration of three factors in determining premium, coverage and deductibles. Moreover, the government should promulgate laws and regulations on complementary medical insurance, strengthen management on this business, system innovation and policy support. And the insurers should further enhance their self　 construction, deepen their understanding of the importance of this business, and improve on their qualit