商业保险参与社会医疗保障的现实模式与发展方向

我国商业保险自21世纪初期开始进行参与社会医疗保障经办服务的探索,各地的实践先后形成了商业保险参与社会医疗保障的＂委托管理模式＂＂保险合同模式＂＂共保联办模式＂等,每种模式均有其特色与优势,也存在瑕疵与不足。未来的＂政保合作＂方向应是＂双重一体化委托管理模式＂,即：打破城乡二元结构,建立城乡一体的医疗保障体系;商业保险以＂委托管理模式＂参与城乡居民基本医疗保险,以＂保险合同模式＂参与城乡居民大病医疗保险,实行＂基本＋大病＂一体化管理。

Implementation Model and Development Direction for Commercialized Insurance Participation and Social Medical Insurance

Chinese commercialized insurance began to explore the participation in social medical insurance service at the beginning of the 21st century, the practice in all parts of China has formed ＂trust-management model＂, ＂insurance-contract model＂ and ＂mutual insurance model＂ and so on in the social medical insurance joined by commercialized insurance, but each model has its feature and advantage and its defect and shortcomings. Future direction of ＂the cooperation between government and insurance company＂ should be ＂double-integrated-trust- management model＂, i.e., breaking the dual structure of urban and rural areas to set up the urban and rural integrated medical insurance system, commercialized insurance participates in the basic medical insurance of urban and rural residents by ＂trust-management model＂, participates in serious disease insurance for urban and rural residents by ＂insurance-contract model＂ , and implements the integrated management of ＂basic medical insurance ＋ medical insurance for serious diseases＂.