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  上海4月20日电(记者陈静)记者20日获悉,刚刚发布的《健康保险蓝皮书——中国健康保险发展报告(2024)》(简称:蓝皮书(2024))显示,整体而言,中国健康保险发展面临良好机遇,并指出,保险业与慢性病管理产业链各方的融合模式仍在初级的探索阶段,商业模式尚未形成。

  在中国社会科学院国家金融与发展实验室、中国社会科学院金融研究所和上海健康医学院联合主办的“健康保险高质量发展研讨会暨第六届健康保险蓝皮书发布会”上,蓝皮书(2024)“出炉”。据此,国家政策加大支持力度为健康保险发展营造了良好制度环境;2011年以来,中国卫生总费用受到来自人口老龄化、疾病谱变化和医疗服务供给扩张三方面因素的叠加影响,呈现持续增长趋势,卫生总费用增速平均高出GDP增速2.5个百分点以上,2023年卫生总费用占GDP的比重达到7.2%。但是,在筹资端,政府卫生支出和基本医疗保障支出很难与之同步增长,这打开了健康保险发展空间。

  《健康保险蓝皮书——中国健康保险发展报告》(简称:蓝皮书)是上海健康医学院和中国社会科学院国家金融与发展实验室合作编写的系列性研究报告,至今连续出版六年,受到了广泛关注。六年来,上海健康医学院联合国家金融与发展实验室,通过打造学科跨界合作研究平台,汇聚了来自政产学研稳定的多专业背景研究队伍,促进健康保险研究成果转化应用。蓝皮书积极呼应改革发展的核心命题,高度关注优先覆盖群众最常用、负担最重的药品的多元支付,高度关注健康管理和慢病管理领域的延伸与发展,高度关注数据为支撑的费用报销和管理准入。

  蓝皮书(2024)指出,从服务民生福祉看,普惠型补充医疗保险(以下简称“惠民保”)发展模式初步经受住了时间检验。近年来,各级政府及有关部门支持商业保险机构开发与基本医疗保险相衔接的商业健康保险产品,覆盖基本医保不予支付的费用,缓解民众“因病致贫”问题,成效显著。以浙江省为例,2023年,浙里惠民保减轻个人负担率为13.50%。

  蓝皮书(2024)总结了典型惠民保模式的运行机理,指出其以满足参保人群“平时有预防、生病有保障”需求为主,具备普惠性、政策性、非营利性和市场性四种属性;实现了市场机制、公益机制与行政机制有机融合和优势互补,为医保筹资难题提供了新解法。

  蓝皮书(2024)基于对三明市、天津市等地政策型慢病管理模式的总结提炼,对保险业参与慢性病管理工作提出两点建议,一是推动公共卫生多元支付体系建设,为慢性病管理提供支付保障;二是发挥资源整合平台优势,参与政策型业务经办,实现优质健康资源的统合与尝试。

  蓝皮书(2024)分析指出,从产品结构看,健康保险发展面临结构调整压力。重大疾病保险依然是中国商业健康保险的主要险种,但其发展面临渠道困境、储蓄功能被寿险产品替代、投保人购买方式转变等带来的挑战,发展前景难言乐观。医疗保险正在迅速崛起,但短期内依然无法撼动重疾险的主力地位。

  据悉,长期来看,健康险结构调整能否顺利完成,取决于医疗保险业务能否实现高质量发展。蓝皮书(2024)认为,医疗保险业务发展路径逐渐清晰,走大众化和高端化并行发展道路,用不同的机制来满足消费者不同的需求。走大众化和普惠化发展道路,应完善社商融合机制,推动普惠型补充医疗保险发展模式成熟定型,明确其政策性保险定位,助力解决基本医保支付政策范围之外的大额医疗费用对一般家庭带来的“因病致贫”问题;走高端化发展道路,则应满足中高收入阶层超过法定医疗保障水平之上的需求。医保丙类目录的制订为高端医疗险带来长期机遇,但需要DRG/DIP医保支付政策进行相应调整。(完)

  青海拉面,以其独特的风味和工艺著称。坐落在青藏高原的东部,化隆县被誉为“拉面之乡”,如今已将这碗承载四千年历史的面食带向世界。化隆籍拉面店近2万家,不仅遍布全国337个城市,更在马来西亚、柬埔寨等16个国家落地生根,成为中外人文交流的美味纽带。这碗跨越千年的面条,见证着中国同周边国家山水相连、人文相亲的深厚情谊。

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