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我国是健康保险不发达国家,商业健康保险覆盖面较低。制约商业健康保险发展的宏观因素有:相关政策不明晰,商业健康保险规模小,地下保单在沿海地区比较猖獗;微观因素有:同业恶性竞争,产品同质化,道德风险存在,精算或经验数据缺乏基础,专业经营人才缺位。加快发展商业健康保险,必须寻求政策机遇;突破传统的“健康保障+健康管理”模式;建立商业保险公司与医疗机构之间的新型战略合作关系;实行专业化经营;提倡人性化服务;细分产品,有效控制风险;实施战略性人才储备。
China is an underdeveloped health insurance country with a low coverage of commercial health insurance. The macroeconomic factors restricting the development of commercial health insurance are as follows: the relevant policies are not clear, the scale of commercial health insurance is small and the underground insurance policies are relatively rampant in the coastal areas. The microeconomic factors include: vicious competition among peers, product homogeneity, moral hazard, actuarial or empirical data Lack of foundation, lack of professional management personnel. To speed up the development of commercial health insurance, we must seek policy opportunities; break through the traditional “health protection + health management” model; establish a new type of strategic cooperative relationship between commercial insurance companies and medical institutions; implement specialized management; promote humanized services; Break down products to effectively control risks and implement strategic talent pool.