健康发展与政策研究2025，Vol.28Issue(3)：245-250,6.DOI:10.12458/HDPR.202407108
可持续的普惠型商业医疗保险:特征、挑战及发展路径
Sustainability of inclusive voluntary health insurance:characteristics,challenges and development path
摘要
Abstract
Objective To analyze the characteristics of inclusive voluntary health insurance(IVHI)that has been operating continuously for many years,and to offer insights for its sustainable development.Methods Taking the IVHI that has been in continuous operation from 2021 to 2023 in China as the research subject,this study analyzed its evolution in terms of security capability,security level and operating results.The development index of IVHI was utilized to measure the development level of each sustainable IVHI in 2021-2023,and the Sankey diagram was used to visualize its evolution characteristics.Results A total of 74(55.22%)IVHI continued to operate in 2021-2023.In parallel,53(71.62%)kept the same annual financing amount.68(91.89%)IVHI retained the same or expanded scope of the coverage,and the percentage of IVHI subject to government guidance rose from 81.08%to 87.84%.82.61%of IVHI enrollment rates either maintained stable or increased.The average deductible remained at 12 200 CNY,while the average reimbursement rate decreased by 5%,and the overall benefit cap increased by 800 000 CNY.The development index increased from 70 to 75(out of 100).The Sankey diagram illustrated the notable increase in the percentage of IVHI with high security capacity and high security levels from 17.57%to 39.19%.In 2023,35.14%of IVHI exhibited a combination of high security capacity and low security levels or low security capacity and high security levels,either of which was not conducive to sustainable development.Conclusions Sustainable IVHI has a stable financing standard and participation scale,established support from the government,a comprehensive scope of the coverage,a steady increase in reimbursement level,and a relatively high development index.However,the IVHI is facing the challenges of imbalance between security capability and security level.It is recommended to leverage the power of multiple parties to jointly increase the participation rate,optimize the design of coverage,and promote the synergistic development of security capability and security level.关键词
普惠型商业医疗保险/可持续发展/发展指数Key words
inclusive voluntary health insurance/sustainable development/development index分类
医药卫生引用本文复制引用
俞纯璐,张璐莹,童禧辰,陈文..可持续的普惠型商业医疗保险:特征、挑战及发展路径[J].健康发展与政策研究,2025,28(3):245-250,6.基金项目
国家自然科学基金项目(72374049) （72374049）
