【作者】 李猛；

【导师】 王选鹤； 王鲁帅；

【作者基本信息】 东北财经大学 ， 保险硕士（MI）（专业学位）， 2022， 硕士

【摘要】 近年来,我国一直重视发展商业健康险,不断提高商业健康险的地位,将其从“补充多层次医疗保障体系”定位为“社会保障体系重要支柱”,鼓励其承担更多的医疗保障责任。这意味着在商业保险领域进行体制改革势在必行。目前我国已出台了多项政策来推进医疗保险制度改革,其中包括推动医保基金投资运营市场化以及加强监管等。但根据美国、英国和德国等发达国家的经验,医疗保障市场既存在社保,也存在商保,行业改革往往侧重于两者之间的衔接。对于我国来说,健康险的发展与社会经济水平、医疗负担等因素都有密切关系,不应过快发展健康险,脱离健康保险业成长的背景状况,做出的目标和展望都是不现实的。本文引入协同理论,首先明确二者的界限,对实践中社会医疗保险和商业健康险的地位和作用进行独立思考和审视。通过对比国外发达国家的健康保险改革重点,认识目前中国商业健康险的不足之处。然后,从社保的角度,分析改革的动力和压力,并与商业健康保险的改革和发展需求进行互动,探讨其协调发展的途径。从独立性、协同性两个方面,因地制宜、因势利导,提出有针对性的政策建议,明确工作重点与方向。使用PVAR模型,对社会医疗保险保费收入、支出,商业健康保险收入和老年人口抚养比进行实证检验,对全国31个省市的面板数据进行分析,通过脉冲响应和方差分解函数判断:在人口老龄化背景下,社会医疗保险对商业健康险的关系;不同地区变量之间的影响程度。得到以下结论:(1)无论在全国还是针对不同地区,总体看来社会医疗保险和商业健康险是相互促进的关系;人口老龄化加剧降低了二者的保费收入,但对前者的影响较大。(2)东部、中部地区的社保和商保发展较为成熟,较西部地区而言,对风险的承受能力更强。应对人口老龄化的冲击,东、中部社会医疗保险收入的波动并不强烈;但商业健康保险的市场性更强,东、中部地区较西部的反应更加强烈,其中东部地区的健康险市场有效性较中部地区更强。本文的创新点在于:第一,引用协同理论。社会医疗保险和商业健康险二者存在功能上的重叠,后者对前者不免有一定的“替代”效应。近些年随着健康保险的迅速增长,二者衔接、协调发展的困难更加明显。本文建立的协同模型强调商业健康保险和社会医疗保险二者的独立性,着重于老龄化和抗疫带来的医疗危机。在模型中,设置“社会医疗保险支出”这一变量。从社会医疗保险的保障功能出发研究社保对商保的影响,探寻二者协调发展的途径,进而发挥商业健康险的“补充”职能,以明确开展多方面合作。更多还原

【Abstract】 In recent years,China has been attaching importance to the development of commercial health insurance,constantly improving the status of commercial health insurance,positioning it from "supplement multi-level medical security system" to"important pillar of social security system",encouraging it to undertake more medical security responsibilities.This means that it is imperative to reform the commercial insurance system.At present,China has issued a number of policies to promote the reform of medical insurance system,including promoting the marketization of medical insurance fund investment and operation and strengthening supervision.However,according to the experience of developed countries such as the United States,The United Kingdom and Germany,there are both social security and commercial insurance in the medical security market,and the industry reform often focuses on the connection between the two.For China,the development of health insurance is closely related to social and economic level,medical burden and other factors,so we should not develop health insurance too fast,divorced from the background of the growth of health insurance,and make goals and prospects are unrealistic.In this paper,we introduce the synergy theory,firstly define the boundary of social medical insurance and commercial health insurance,and independently think and examine the status and role of social medical insurance and commercial health insurance in practice.By comparing the key points of health insurance reform in developed countries,the deficiencies of commercial health insurance in China are understood.Then,from the perspective of social security,it analyzes the driving force and pressure of reform,interacts with the reform and development needs of commercial health insurance,and discusses the way of its coordinated development.From the two aspects of independence and coordination,we should take measures in light of local conditions and adapt to the situation,put forward targeted policy suggestions,and clarify the focus and direction of our work.Using PVAR model of social medical treatment insurance premium income,spending,commercial health insurance income and the elderly population bring-up ratio for empirical testing,analysis of panel data of 31 provinces and cities across the country,through the impulse response function and variance decomposition to judge:under the background of population aging,social medical insurance on the relationship between the commercial health insurance;The degree of influence between variables in different regions.The following conclusions can be drawn:(1)social medical insurance and commercial health insurance are mutually promoting in general,whether in the whole country or in different regions;The aging of population reduces the premium income of both,but has a greater impact on the former.(2)The development of social security and commercial insurance in eastern and central regions is more mature,and the risk tolerance is stronger than that in western regions.To cope with the impact of aging population,the fluctuation of social medical insurance income in eastern and central China is not strong;However,the market of commercial health insurance is stronger,and the response of eastern and central regions is stronger than that of western regions,and the effectiveness of health insurance market in eastern regions is stronger than that in central regions.The innovation of this paper lies in:first,the theory of collaboration is cited.Social medical insurance and commercial health insurance overlap in functions,and the latter inevitably has a "substitution" effect on the former.In recent years,with the rapid growth of health insurance,the difficulties in the connection and coordinated development of the two have become more obvious.The collaborative model established in this paper emphasizes the independence of commercial health insurance and social health insurance,and focuses on the medical crisis caused by aging and anti-epidemic.In the model,the variable of "social medical insurance expenditure" is set.Starting from the security function of social medical insurance,this paper studies the influence of social security on commercial insurance,explores the way to coordinate the development of the two,and then gives full play to the"supplement" function of commercial health insurance,so as to clearly carry out multi-faceted cooperation.更多还原