我国健康保险业的健康管理运行模式构建

健康管理是健康保险转移财务风险、控制成本、解决信息不对称、道德危害等问题的成功策略之一。积极借鉴国外保险业健康管理的成功运行模式(如HMO,PPO,POS等),构建我国健康保险的健康管理运行模式对于我国健康保险业的可持续发展有着重大意义。本文重点研究了健康管理运行模式的重要组成部分:服务人群、服务方式、服务内容、支付机制、成本控制与医疗服务管理机制、利益协调机制、反馈机制等,并探讨了健康管理当前在我国面临的问题,指出必须结合国情构建健康管理运行模式,从而促进我国健康保险业务稳定、持续、健康的发展。

A research on constructing the health management operation model for health insurance business in chinalife

Health management is one of the successful strategies of health insurance to transfer financial risks,control costs,solve the problem of information asymmetry,and reduce moral hazards etc.It is of great significance for the sustainable development of health insurance to establish a health management mode for the insurance industry by drawing lessons from abroad(for example,HMO,PPO,POS etc.).This paper focused on major components of the health management model,such as targeted population,service style,servic...