金融学院知识库

    随着我国医疗保障制度的不断完善和人民群众健康需求的日益增长，普惠型商业医疗保险作为一种新型医疗保障形式应运而生。普惠型商业医疗保险具有保费低廉、保障高、不限制参保条件等特点，一经上线，便获得群众的欢迎。甘肃省作为西部地区的代表接连推出“金城·惠医保”和“陇惠保”两款普惠型商业医疗保险，旨在为全省广大民众提供全面、便捷的医疗保障。基于此，文章以甘肃省普惠型商业医疗保险为研究对象，分析其运营效果，总结其存在的问题并提出相关建议，旨在为完善多层次医疗保险体系提供有益参考。

    文章采用案例分析法和比较分析法。首先，介绍了相关概念和相关理论；接着，从四个方面阐述了我国普惠型商业医疗保险的发展现状；然后，以“金城·惠医保”和“陇惠保”为案例研究对象，从投保现状、参与主体、保障责任、产品特点和理赔效果五个方面分析其运营效果，总结了甘肃省普惠型商业医疗保险发展中存在的问题，分析了出现这些问题的原因；最后，通过比较与百万医疗保险在投保门槛、保障责任和健康增值服务的异同以及借鉴丽水和广州两个地区成功经验的基础上，对甘肃省普惠型商业医疗保险的发展中的问题提出建议。

    研究发现甘肃省普惠型商业医疗保险在提升群众医疗保障水平、缓解看病难、看病贵问题等方面发挥了积极作用。然而，其仍面临着参保率过低、实际保障能力不足、参与主体权责不清晰、信息公开不透明等问题。基于以上问题，提出提升参保率，促进可持续发展；增强保障能力，明确保障重点；突出政府指导，促进政企合作；完善信息公开机制；强化监管机制和风险管理的相关建议，旨在通过促进甘肃省普惠型商业医疗保险可持续发展，以满足人民群众日益增长的医疗保障需求。

       With the continuous improvement of China's medical insurance system and the growing health needs of the people, universal commercial medical insurance has emerged as a new form of medical insurance. Universal commercial medical insurance is characterized by low premiums, high protection, and no restriction on enrollment conditions, etc., and has gained popularity among the public since its launch. Gansu Province, as a representative of the western region, has successively launched "Jincheng-Huimedicine Insurance" and "Longhui Insurance", aiming to provide comprehensive and convenient medical insurance for the general public in the province. Based on this, the article takes the universal commercial medical insurance in Gansu Province as the research object, analyzes its operation effect, summarizes its existing problems and puts forward relevant suggestions, aiming to provide useful reference for improving the multi-level medical insurance system.

      The article adopts case study method and comparative analysis method. Firstly, it introduces the relevant concepts and theories; then, it elaborates the development status of universal commercial medical insurance in China from four aspects; then, it takes "Jincheng-Huimedicine Insurance" and "Longhui Insurance" as the case study objects, and analyzes their operation effects and summarizes their problems and makes relevant suggestions, aiming to improve the multi-level medical insurance system as well as provide useful references, Then we take "Jincheng-Health Insurance" and "Longhui Insurance" as the case study objects, analyze their operation effects from five aspects: the insured status, the participating subjects, the protection responsibilities, the product characteristics and the claim effects, and summarize the problems in the development of inclusive commercial medical insurance in Gansu Province; finally, based on comparing the differences and similarities with the millions of medical insurance in the threshold of the insurance, the protection responsibilities, and the value-added health services as well as drawing on the successful experiences of Lishui and Guangzhou, we put forward the suggestions for the problems in the development of the inclusive commercial medical insurance in Gansu Province. The study found that Gansu Province has a high threshold for universal commercial medical insurance.

            The study finds that universal commercial medical insurance in Gansu Province has played a positive role in enhancing the level of medical protection for the public and alleviating the problems of difficult and expensive access to medical care. However, it still faces problems such as too low participation rate, insufficient actual protection capacity, unclear rights and responsibilities of participating subjects, and non-transparent information disclosure. Based on the above problems, we put forward the relevant suggestions of improving the participation rate and promoting sustainable development; enhancing the protection capacity and clarifying the focus of protection; highlighting the guidance of the government and promoting the cooperation between the government and enterprises; perfecting the information disclosure mechanism; and strengthening the supervision mechanism and risk management, aiming at promoting the sustainable development of the universal commercial medical insurance in Gansu Province, so as to satisfy the people's increasing demand for medical protection.