【作者】 龚贻生；

【导师】 朱铭来；

【作者基本信息】 南开大学 ， 保险学， 2012， 博士

【摘要】 健康是人全面发展的基础，是影响社会经济发展的重要因素。建立和完善健康保障体系，更好地保障民众健康，已经成为各国政府保障民生的重要政策。商业健康保险是国家健康保障体系的有机组成部分，是保险业发挥社会风险管理功能、更好地服务经济社会的重要业务领域，应该在国家健康保障体系中发挥更大作用。本文紧紧围绕我国商业健康保险发展问题，从国内外商业健康保险发展的理论与实践出发，通过分析国内外商业健康保险发展历程和现状，深入探究我国商业健康保险发展路径。本文从商业健康保险的发展规律探索出发，探索适合我国商业健康保险发展的途径。从理论的角度，总结健康保险需求和供给的影响因素，分析商业健康保险在医疗保障体系中的功能定位，探索商业健康保险发展规律。总结国际商业健康保险发展的经验与教训，分析各国发展商业健康保险的激励机制，为我国商业健康保险的发展提供借鉴。分析我国商业健康保险的发展历程、存在问题，并建立模型预测我国商业健康保险的发展前景。提出我国商业健康保险发展的对策和政策建议，指导和推动我国商业健康保险的发展。研究商业健康保险的发展路径具有重要的理论和实践意义，主要表现在：第一，有利于总结国际商业健康保险发展的经验和教训。第二，对于我国商业健康保险的发展具有重要的指导和借鉴意义。第三，有利于我国应对人口老龄化加速到来的趋势，从而实现可持续发展的医疗保障制度的战略研究。论文共七章，第一章是绪论，第二章和第三章是理论研究部分，第四章是国际经验研究，第五章和第六章是我国的现状和外部环境分析，第七章是我国商业健康保险发展路径研究。第一章主要阐述了研究背景、目的意义、方法和论文结构内容等。第二章主要阐述了健康保险的基本经济理论综述，重点对健康与医疗的需求和健康保险需求等基本理论进行综述，一是阐述了健康的定义和经济学上的意义，二是阐述了健康保险需求的一般理论模型。三是阐述了健康保险需求的特殊理念。第三章主要阐述了医疗保障体系中的商业健康保险的功能定位、匹配模式和政策激励问题；描述了商业健康保险在医疗保障体系中的功能定位，分析了医疗保障体系的构成、商业健康保险在不同的医疗保障模式中角色地位不同，提出商业健康保险是医疗保障制度可持续发展的建设者，认为商业健康保险能够满足民众多样化的健康保障需求和提高民众健康保障水平、提高医疗保障制度的管理效率和提高医疗保障基金的利用效益、促进医疗资源的合理配置和利用。分析了商业健康保险和社会医疗保险的配置模式。通过分析主要国家对商业健康保险的税收优惠政策以及美国在团体健康保险、个人健康保险、自由职业者的健康保险和政府医疗保障项目等方面财税优惠政策的具体做法，分析商业健康保险的税收激励机制，得出税收优惠政策对商业健康保险发展的影响途径。第四章分析了美国商业健康保险发展路径、英国商业健康保险发展路径、德国商业健康保险发展路径，对国际商业健康保险发展经验进行了总结，分析了世界各国医疗保健费用急剧上升的原因，提出各国政府都注重发挥商业健康保险保障方式灵活、保障领域全面等优势，以弥补社会保障体系的不足，更好地满足老龄人口多元化、多层次的健康保障需求的启示。第五章重点分析了我国商业健康保险市场的发展历程和特点，描述了保险业参与多层次医疗保障制度建设的概况，对我国商业健康保险市场存在的主要问题进行了分析；总结了我国商业健康保险市场的发展历程和存在的主要问题我国商业健康保险市场规模有限、专业化经营水平低、风险控制能力有待提高和产品同质化严重。第六章分析了我国商业健康保险进一步发展的外部环境，对商业健康保险的发展前景进行了预测；分析了我国商业健康保险进一步发展的外部环境，提出社会经济发展有利于商业健康险需求的增长、医药卫生体制改革为商业健康保险的发展创造了良好的环境等观点，在分析我国人口老龄化对商业健康保险发展影响的基础上，对我国商业健康保险的发展前景进行了预测。第七章对我国商业健康保险发展路径进行了分析，提出了加强商业健康保险的顶层设计的对策建议，描述了推进健康保险专业化发展的路径，对创新保险公司经营模式与业务发展战略提出了思路，对保险公司健康风险管理和保险监管战略提出了建议。更多还原

【Abstract】 Health plays an important role in the social economicdevelopment. Establishing and improving the health protection systemhas become an important policy of the governments to protect the healthof the people. Commercial health insurance is an integral part of thenational health security system. It plays a social risk managementfunction and serves key business areas of the economy and society.Commercial health insurance should play a greater role in the nationalhealth security system. This paper closely elaborates the development ofcommercial health insurance in China, through the development of thetheory and practice of commercial health insurance, analysis of thehistory and current situation of the development of domestic and foreigncommercial health insurance, explore the development path of China’scommercial health insurance. From the law of development of the commercial health insurance,we explored the way for development of commercial healthinsurance. From a theoretical point of view, we summed up the impactof health insurance demand and supply factors, analysised the functionalposition of the commercial health insurance in the medical securitysystem, explored the development law of commercial healthinsurance. We analysised the experiences of countries’ development ofhealth insurance and the incentives for countries to develop commercialhealth insurance, provided a reference for China’s development ofcommercial health insurance. We proposed development strategies andpolicy recommendations for commercial health insurance,with the wishof guiding and promoting the development of commercial healthinsurance.The research of the development path of commercial healthinsurance has important theoretical and practical significance.Firstly, summarize the experiences and lessons of internationalcoutries’development of health insurance. Secondly, the development ofcommercial health insurance has an important guide and reference toChina. Thirdly, in order to face the trend to accelerating the arrival of anaging population, we should achieve the strategic research forsustainable development of the medical insurance system.This paper has seven chapters, the Chapter1is an introduction,Chapters2and3are the theoretical research, the Chapter4talks theinternational experience of the development of commercial healthinsurance, Chapters5and6are China’s current situation and externalenvironment analysis of commercial health insurance, Chapter7isChina commercial health insurance development path.The Chapter1described the research background, purpose andsignificance, methods and thesis structure content.In Chapter2we reviewed basic economic theory of the health insurance, described the definition of health and economics,the generaltheoretical model of health insurance demand, special concept of thehealth insurance needs. We focued on health care needs and demand forhealth insurance.The Chapter3described the functional position of the commercialhealth insurance in the medical security system,and the match patternsand policy incentives; described the functional position of thecommercial health insurance in the medical security system, thecomposition of the medical security system.Commercial healthinsurance plays different roles and status in a different mode of healthcare protection. Wuth sustainable development,the commercial healthinsurance medical security system builders should meet people’s diversehealth protection needs, improve the level of public health protectionand the medical insurance system management efficiency, improve theuse efficiency of the medical insurance fund, promote the rational allocation and utilization of medical resources. By analyzing thespecific practices of the preferential tax policies of the major countriesas well as the group health insurance, individual healthinsurance,freelance health insurance and government medical insuranceprograms and taxation preferential policies of commercial healthinsurance tax incentivesmechanism,we drew the way of preferential taxpolicies for the development of commercial health insurance.Chapter4analyzes the path of U.S. commercial health insurance,the development path of the British and German commercial healthinsurance, we summaried international experiences in the developmentof commercial health insurance. Analysising of the reasons for the sharprise of the world health-care costs, we proposed Governments payattention to the advantage of the commercial health insurance as thereason of compensating for the deficiencies of the social security system,better meeting the diversification of the aging population. The Chapter5focuses on the history and characteristics ofcommercial health insurance market in China, describes the insuranceindustry’s participation in multi-level medical security system, and anoverview of the main problems of the commercial health insurancemarket; we summaried the problems of the commercial health insurancemarket:the limited size of the main problems of commercial healthinsurance market, the low level of professional management and riskcontrol ability needs.The Chapter6analyzes the external environment of commercialhealth insurance; predicts the prospects,analysis of the externalenvironment for the further development of commercial healthinsurance.We proposed that socio-economic development is conduciveto the growth for commercial health insurance demand, so as themedical and health system.Also China’s aging population will affect thedevelopment of commercial health insurance. The Chapter7analysised the development path of China’scommercial health insurance, put forward a few suggestions tostrengthen top-level design of the commercial health insurance.Wedescribed the path of advancing the professional development of healthinsurance.To insurance company,we innovated business model andbusiness development strategy ideas on health risk management andinsurance regulatory strategy recommendations.更多还原