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健康保险由于经营风险大、管理成本高、管理难度大,面临普遍发展难题。过度医疗、逆选择等外界风险的大量存在,成为健康保险的发展瓶颈,健康保险产品创新成为走出困境的希望之路。因此,在产品创新导向上要注重将健康保险自身规律与市场需求规律有机结合,建立起以保险机构专业化经营管理为前提、以健康管理为基础、以保险机构与医疗机构有效合作为保证的健康保险风险控制机制;建立起以普遍性需求为主导、以区域性和个性化需求为辅助的集中与分散相结合的健康保险产品研发体制;创造出政府政策支持和具体优惠政策并举、社会医疗保险与商业健康保险两个优势均能得到充分发挥的政策环境。
Health insurance is faced with the problem of universal development due to its high management risks, high management costs and difficult management. Excessive medical treatment, adverse selection and other external risks in large numbers, become the development bottleneck of health insurance, health insurance product innovation has emerged as a hope out of the woods. Therefore, in the direction of product innovation, we should pay attention to the combination of the laws of health insurance with the laws of market demand, establish the specialization of insurance institutions as the precondition, take health management as the foundation, and ensure the effective cooperation between insurance institutions and medical institutions Health insurance risk control mechanism; establish a system of R & D of health insurance products which is dominated by universal demand and centralized and decentralized with regional and individualized needs; creates both government policy support and specific preferential policies, social health care Both the insurance and commercial health insurance advantages give full play to the policy environment.