健康发展与政策研究2025，Vol.28Issue(5)：546-551,6.DOI:10.12458/HDPR.202410092
江苏省惠民保发展形势和问题研究
Research on the development trends and challenges of Huimin insurances in Jiangsu Province
摘要
Abstract
Objective This study aims to analyze the development trends,implementation effectiveness,and existing challenges of an inclusive commercial medical insurance(hereinafter referred to as"Huimin insurances")in Jiangsu Province,and to propose suggestions for its sustainable development.Method This paper reviewed Huimin insurances products launched nationwide from 2020 to 2024,and combined textual analysis,comparative analysis and semi-structured interviews to analyze the coverage situation of Huimin insurances in Jiangsu Province from the perspective of product design.Results Huimin insurances in Jiangsu Province achieves risk sharing through a multi-party co-insurance mechanism.It effectively supplements basic medical insurance by leveraging an inclusive model with"three no-restrictions"(no restrictions on age,occupation,or health status)and"low premiums with high coverage".The program has also upgraded its list of specific high-priced drugs and expanded its coverage responsibilities on an on-going basis.However,challenges persist,including an imbalanced enrollment structure,inadequate coverage for rare diseases,prominent product homogenization,and ambiguous rules for the list of specific high-priced drugs.Conclusion Huimin insurances in Jiangsu Province has been developing steadily with a promising trend,yet it faces challenges such as structural imbalances and institutional deficiencies.To promote its sustainable development in Jiangsu Province,it is recommended to adopt measures including the structure optimization of insurance enrollees,coverage expansion for rare diseases,a more differentiated product design,and more standardized selection mechanism for specific high-priced drugs.关键词
普惠型商业医疗保险/可持续发展/保障待遇Key words
inclusive commercial medical insurances/sustainable development/coverage分类
预防医学引用本文复制引用
智屹婷,席晓宇,朱铭来,林伊莎,王恩楠..江苏省惠民保发展形势和问题研究[J].健康发展与政策研究,2025,28(5):546-551,6.基金项目
教育部人文社会科学研究青年项目(23YJCZH204) （23YJCZH204）
江苏高校哲学社会科学一般项目(2023SJYB0297) （2023SJYB0297）
