保险学-商业健康保险在全民医保中的定位研究.docx

商业健康保险在全民医保中的定位研究 【摘要】在对医疗保障结构不断努力完善的状况下，全民医保已经基本实现。其中，商业健康保险和基本医疗保险是其的主要构成，但是它们在全民医保中的地位却有所不同。商业健康保险的定位随着政策和经济环境的变化，由最初的补充作用，演变为补充与参与作用。本文通过对数据和政策分析，探讨全民医保的发展现状，讨论全民医保存在的问题，着重分析商业健康保险在弥补基本医疗保险不足方面的优势，体现其的补充参与作用。另外，结合当前商业健康保险发展状况，分析其发展不足原因，并提出相应的解决方法。 【关键词】商业健康保险、基本医疗保险、补充与参与作用 A Study on the Status of Commercial Health Insurance in Universal Medical Insurance [Abstract] In virtue of improving the medical-insurance system, universal medical insurance has been basically achieved in China. Among them, commercial health insurance and basic medical insurance are important parts of it, but their positions in universal medical insurance is different. With the change of policy and economic environment, the positioning of commercial health insurance has changed from the original supplementary role to the supplementary and participating role. Through the analysis of data and policy, this paper discusses the current situation of universal medical insurance as well as the problems existing in universal medical insurance, and focuses on the advantages of commercial health insurance in making up for the shortage of basic medical insurance, so as to reflect its complementary and participating role. In addition, combining with the current development status of commercial health insurance, this paper also analyzes the reasons for its deficiency in the development process and puts forward the corresponding solutions. [Keywords] Private health insurance Fundamental health care Complementary and participatory roles 目 录 TOC \o 1-3 \h \z \u 1 前言 1 2 全民医保现状 3 2.1 基本医疗保险 3 2.1.1 基本构成 3 2.1.2 参保人数逐年上升，覆盖面广 5 2.1.3 医保基金收支规模扩大 6 2.2 补充医疗保险 7 2.3 商业健康保险 8 2.3.1 基本状况 8 2.3.2 专业健康保险公司兴起，保险产品种类多 9 2.3.3 保费收入增速快，占比增大 9 2.3.4 保费支出同步增长 11 2.3.5 保险深度与保险密度逐步提升 11 2.4 城乡救助制度 12 2.5 商业健康保险与基本医保的定位对比 12 3 全民医保存在的问题 14 3.1 保障水平低 14 3.2 基本医保收支不平衡 15 3.3 保险业务与责任边界不清晰 16 3.4 医疗卫生体制不够完善 17 4 商业健康保险的补充参与作用 19 4.1 提高保障水平，补充卫生支出 19 4