商业保险机构经办社会医疗保险可行性分析.pdfVIP

Z土D 商业保险 商业保险机构经办 社会医疗保险可行性分析 沈华亮 (深圳市社会保险基金管理局深圳 518026) E摘要】政府设立的医保机构经办社会医疗保险业务的主体地位绝对不能轻易改变。国外放开社会 医疗保险经办管理的做法是不可取的。美国是最典型的例子，许多商业保险公司承办医疗保险，保险机 构之间竞争非常剧烈，在强大的医疗卖方面前难以形成合力，在很大程度上造成美国医疗费用居高不 丁.我国应该从中汲取教训。商业保险机构经办社会医疗保险业务在有些方面可以探索. E关键词】商业保险;社会医疗保险;经办;可行性 E 中固分类号】 f840.684 C913.7 【文献标识码】 A 【文章编号】 1674-3830(2011)12-64-4 doi: 10.369jj.issn.1674-3830.2011.12.17 哑he Feasib出ty Analysis of Commercial Insurance Company pro世ding Social Medical Insurance Service Hualiang Shen (Social Insurance Fund Administration of Shenzhen Municipality, Shenzhen, 518026) [AbstractJ The social medical insurance agencies established by govemment are in the dominant position, which absolutely should not be changed. It is not desirableωpermit all kinds of agencies to provide social medical insurance service. Taking an example, many commercial insurance companies provide medical insurance 阳vice in America. The competition among 也e companies is so fierce that it is hard to 岛rm the joint effort to face with the pow宵ful medical service providers , which leads to the expensive medical expenses in America. We should learn from mistakes happened in these countries. It could be explored to permit commercial insurance companyωprovide some kinds of social medical insurance service in some way. l Key wordsJ commercial insurance, social medical insurance, management, feasibility 利益驱使下，医疗市场出现过度检 探索商业保险机构经办社会医 保险业务存在的隐忧 疗保险业务，已成为我国人力资源 查、过度治疗、滥用高价药、滥用 社会保障部门和商业保险机构近期 1.1 商业保险机构经办社会医 贵重医用材料、乱收费的现象，甚 关注的热点问题之一.本人就商业 疗保险业务，不利于医疗市场由卖 至出现天价事件。医疗保险经办 保险机构经办社会医疗保险业务的 方市场向买方市场转变 机构是参保人的利益代表，随着全 可行性