北京航空航天大学学报(社会科学版) ›› 2015, Vol. 28 ›› Issue (1): 13-16.DOI: 10.13766/j.bhsk.1008-2204.2014.0395

• 本期特约专家稿件 • 上一篇    下一篇

商业补充医疗保险参保因素的Logistic分析

贾洪波   

  1. 北京航空航天大学 社会保障研究所, 北京 100191
  • 收稿日期:2014-08-21 出版日期:2015-01-25 发布日期:2015-01-24
  • 作者简介:贾洪波(1976-),男,甘肃镇原人,副研究员,博士,研究方向为社会医疗保障.
  • 基金资助:

    2014年度国家社会科学基金一般项目(14BRK020);2013年度国家留学基金资助项目(留金发[2013]3050号);2013年度中央高校基本科研业务费项目(YWF-13-D2-RW-07)

Logistic Analysis on Factors of Buying Private Supplementary Medical Insurance in China

Jia Hongbo   

  1. Institute of Social Security, Beijing University of Aeronautics and Astronautics, Beijing 100191, China
  • Received:2014-08-21 Online:2015-01-25 Published:2015-01-24

摘要:

同等条件下城乡居民是否参加商业补充医疗保险主要受3个因素的影响,即商业补充医疗保险是否允许优先点名某一医务工作者提供服务;商业补充医疗保险是否支付基本医疗保险基金支付个人门诊费用后的自付部分;商业补充医疗保险承保人是否定期提供疾病预防、健康咨询、健康评估、健康教育等方面的信息。为了扩大商业补充医疗保险的覆盖面,需要商业补充医疗保险提供者和医疗服务机构密切合作以提供优惠、优先医疗服务;需要商业补充医疗保险提供者把费用报销的重点放在报销基本医疗保险基金支付个人门诊费用后的自付部分;需要商业补充医疗保险提供者积极为被保险人提供疾病预防等方面的健康促进活动。

关键词: 多层次医保体系, 商业补充医疗保险, 参保决定, Logistic 模型, 健康促进

Abstract:

The purchase of Private Supplementary Medical Insurance (PSMI) on the part of urban and rural residents are affected by three factors with other things being equal: whether the contract of PSMI permits the insured to select physicians to provide medical care in priority, whether PSMI withdraws the surplus outpatient fees after paying by the basic medical insurance and whether the insurer of PSMI provides information such as disease prevention, health consultation, health assessment and health education. In order to extend the coverage of PSMI, it is necessary to establish a close cooperation between the insurer of PSMI and medical organizations to provide privileged and prioritized medical care, to let the insurer of PSMI place the attention of withdraw of medical fees to the surplus outpatient fees after paying by the basic medical insurance, to let the insurer of PSMI provide the health promotion services such as disease prevention to the insured.

Key words: multi-level medical security system, Private Supplementary Medical Insurance (PSMI), decision to buy the PSMI, Logistic Model, health promotion

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