大病保险制度下政府与保险公司的角色定位分析.pdfVIP

第 29 卷第1 期 VoL 29 No.l 保险职业学院学报{双月刊} 2015 年 2 月 JOURNAL OF INSURANCE PROFESSIONAL COLLEGE( Bimonthly) Feb. 2015 大病保险制度下政府与保险公司的角色定位分析 吴海波，何冲 (江西中医药大学经济与管理学院，江西南昌 33∞04) [摘 要] 公共产品的供给理论表明，大病保险制度下明确政府与保险公司的角色定位具有合理性与必要性。作为 大病保险的"提供者"，政府的主要职责是发布大病保险相关政策文件、制定相关实施方案与细则、对大病保险的运行情况 进行监管、做好大病保险的宣传与推广等。而作为大病保险的"生产者"，保险公司则主要负责大病保险条款的制定、产品 的设计、定价、为参保群众提供核保、理赔以及售后服务等方面的工作;同时保险公司还可通过开展医保合作，控制不合理 医疗费用的非正常增长。总之，政府与保险公司的分工协作，不仅能充分发挥各自的优势，做到优势互补，而且还能大大提 高大病保险的运作效率、服务水平和整体质量。 [关键词] 大病保险;政府;保险公司;提供者;生产者 [中图分类号] F842. 6 [文献标识码]A [文章编号] 1673 -13ω(2015)01-∞57 -05 [ Abstract] The theoηof public product supply indicates that there is rationality and necessity make cle缸 the roles of the government and insurance companies. As the "provider" of the serious illness insurance ，出e main duty of the government is to issue related policies and documents on serious illness insurance , formulate rel- evant implementation and particulars , regulate the operation of the serious illness insurance , publicize and pro- mote the serious illness insurance , etc. As the "producers" of the serious illness insurance , the insurance com- pany is mainly responsible for the draft of serious illness insurance clause鸣， product design , pricing , underwrit- ing and settling claims , after - sale service and other ωpects of the work. At the same time , the insurance com- pany can also control the non - normal growth of the unreasonable medical expenses through the development of medical insurance cooperation. In short , the gove口unent and insurance company' s cooperation , can not only fully play their respective advantages , achieve complementary advantages , but also can greatly improve operation efficiency , service