金融学院知识库

随着疾病谱变化、医疗需求多元化、人均可支配收入提高，以及国家对人民健康重视程度的加深，健康保障有了更高的要求，但目前我国的多层次医疗保障体系尚不能满足民众不断增长的健康保障需求。城市定制型商业医疗保险正是此背景下商业健康保险助力实施健康中国战略和完善多层次医疗保障体系的积极探索。城市定制型商业医疗保险的发展极其迅速，在2021年3月，甘肃省以兰州市为试点，推出了省内首款城市定制型商业医疗保险——“金城·惠医保”，“金城·惠医保”在发展中取得了一定的成效，但也存在许多需要完善的问题，因此，本文着重研究兰州市“金城·惠医保”的发展。

本文先对城市定制型商业医疗保险进行了概念界定和相关理论的讨论，再根据城市定制型商业医疗保险的发展背景及我国的多层次医疗保障体系现状，阐释城市定制型商业医疗保险具备的属性和相应的功能定位，之后从六个方面对兰州市“金城·惠医保”的发展现状进行分析，可以发现方案在实施过程中取得了一定的成效，包括开通了医保个人账户参保，打造“一站式”理赔模式，实现政府与市场协同发展，提高管理效能。同时，也发现目前“金城·惠医保”尚存在参与主体权责不清晰、实际保障不足、参保率低与死亡螺旋及信息披露不足的问题。于是，后文针对上海“沪惠保”、丽水“浙丽保”等产品的实施经验进行探讨。基于以上的问题研究与经验借鉴，对“金城·惠医保”的发展提出相关建议：明确政府定位，促进政商合作；明确保障重点，提升服务质量；巩固监督管理机制，提升监管效能。

With the changes in the disease spectrum，the diversification of medical needs，the increase in per capita disposable income，and the deepening of the country's emphasis on people's health，health security has higher requirements. However，at present，China's multi-level medical security system cannot meet the growing needs of the people for health protection. Under this background，urban customized commercial health insurance is an active exploration of commercial health insurance to help implement the Healthy China strategy and improve the multi-level medical security system. The development of urban customized commercial medical insurance is extremely rapid. In March 2021，Gansu Province launched the province's first urban customized commercial medical insurance，"Jincheng Hui Medical Insurance"， with Lanzhou City as a pilot. "Jincheng Hui Medical Insurance" has achieved certain results in its development， but there are also many problems that need to be improved. Therefore， this article focuses on the development of "Jincheng Hui Medical Insurance" in Lanzhou City.

This article first defines the concept of urban customized commercial medical insurance and discusses relevant theories. Then，based on the development background of urban customized commercial medical insurance and the current situation of China's multi-level medical security system，it explains the attributes and corresponding functional positioning of urban customized commercial medical insurance. Then，it analyzes the development status of "Jincheng Hui Medical Insurance" in Lanzhou from six aspects，It can be found that the plan has achieved certain results in the implementation process，including opening a personal account for medical insurance participation，creating a "one-stop" claim settlement model，achieving coordinated development between the government and the market， and improving management efficiency. At the same time，it is also found that there are still problems with unclear rights and responsibilities of participants，insufficient actual protection，low participation rate，death spiral，and insufficient information disclosure in the current "Jincheng Hui Medical Insurance". Therefore，the following article uses the case analysis method to explore the implementation experience of Shanghai "Huhui Insurance"，Lishui "Zheli Insurance " and other products. Based on the above research and experience，relevant suggestions are proposed for the development of "Jincheng Hui Medical Insurance": clarify the government's positioning and promote the integration of social and commercial cooperation；Clarify the key points of guarantee and improve service quality；Accurately identify preexisting patients and break the death spiral；Consolidate the supervision and management mechanism and improve regulatory efficiency.