| How to solve the social medical insurance problems is always the big challenge to establish and consummate the social security systems for the government. Whatever it’s the government to take charge of and administrative department take responsible for social insurance operation mechanism or it’s the market forces to administrate the social insurance operation mechanism with the government playing the role of supervision and policy make which are the miscellaneous functions, they happen to much trouble. For example, it ensures a broad coverage but loses the efficiency of the insurance and cause the poor quality of service at the same time, or it ensures the efficiency of the insurance and good quality of service but excludes many vulnerable people from the coverage of the social insurance. Through the ten years of endeavor, the coverage rate of our social medical insurance has surpassed90%, but the efficiency and equity of social insurance are far from the goal, In2009, the government promoted the policy about encouraging the private insurance companies to participate in the management of social medical insurance. Hence, the governments of Zhanjiang, Xinxiang, Jiangyin, and Xiamen promoted their measures to try the cooperation between private insurance and social medical insurance. The practices proved the "Zhanjiang model","Xinxiang model","Jiangyin model", and "Xiamen model" achieved success in a certain degree. But these models are limited to their territories, the difference among them is quite big, meanwhile these models have some problems in the way of cooperation and operation model. Can we find a kind of universal operation model and evaluation mechanism of the private insurance company participation in management of social insurance to help other region develop the social insurance? Stemming from the idea just mentioned, this dissertation aim to propose the selection of mode and supporting policies, and establishes the index analysis system of performance evaluation from studying the theory of private insurance’s participation in the management of social medical insurance, combining the practice and experience of private insurance’s participation in the management of social medical insurance in developed countries and developing countries, and based on the comparative analysis between the model of private insurance’s participation in social medical insurance in the typical areas as well.The dissertation composes of six parts, the followings are the main contents and opinions:The first part discusses the research objective and research meaning, and makes the review of the relevant researches of private insurance’s participation in management of social medical insurance, home and abroad, and make a brief introduction of research contents and methods.The second part is the theoretical basis of private insurance’s participation in the management of social medical insurance. Firstly, based on the theory research mainly, it prepares theoretical foil for the later chapters. Starting from the angle of resources allocation, the dissertation compares and analyzes the difference function between the government resources allocation and market resources allocation in the medical insurance market. The disadvantage of the government resources allocation is easier to cause the low efficiency of the operation and management, and the disadvantage of the market resources allocation is causing the market failure and declining the equity, so it is the right choice to apply the combination of the government and market resources allocation to deal with the problems of insurance market. Secondly, the part discusses briefly the interaction between the private insurance and social insurance in China, which suggests they complement each other under some circumstance, and substitute each other under other circumstance. At last, the transitions of government function and purchase service form the market are necessary in the market economics. From bureaucracy government to public management government, from the dual identity of being both referee and player to being player only, it will help improve the equity and efficiency of medical insurance market for the government put emphasis on the policy making and supervision on the market.The third part is the practice and experience studying of private insurance companies’participation in management of social medical insurance abroad. The dissertation mainly analyze the practice and experience of the private insurance companies’participation in management of social medical insurance in developed countries such as Germany, UK, Netherlands and the United states and the developing countries such as Chile, Lebanon, and India.The research suggests that the practices of the developed countries indicate policy-oriented medical insurance can’t depend on the operation by the administrative department and private insurance company alone. Whatever the social insurance or private insurance play the primary role, the selection of model of the policy-oriented medical insurance should take the economic development of the country, the degree of the mature of the private insurance market, and economies and finance of the country into the account. By analyzing the experience and practice of the developing countries, there are two points worth of being learnt:one is market mechanism has default and the government needs to supervise private insurance company; the other is it is very harder to develop social security to depending on private insurance.The fourth part is the comparison among private insurance companies’ participation in management of social medical insurance in typical areas. The dissertation mainly introduces and compares the practice and experience of private insurance companies’participation in management of social medical insurance."Zhanjiang model","Xinxiang model","Jiangyin model", and "Xiamen model" are all achieve success in the certain degree, but the dissertation study these model in order to find the solidarity of inner operation mechanism of these successful model, summarize the practice for private insurance companies’participation in management of basic social medical insurance and major illness medical insurance, and also make the preparation for designing the propagable operation mechanism to other region.The fifth part is the selection of the model and supporting measures of private insurance companies’participation in management of social medical insurance. Firstly, the dissertation comes up with the selection of the model and mechanism designation of private insurance companies’participation in management of major illness medical insurance and basic social medical insurance. It believes the primary operation model of the major illness medical insurance is insurance contract operation model, meanwhile the primary one of the basic medical insurance is fund management operation model. Secondly, there are supporting measures from three aspects:motivating the private insurance companies’ participation in the management of social medical insurance, supervision and support toward the development of social medical insurance, and coordination mechanism of the relative administrative department. Lastly, according to the goal of private medical insurance’s participation in social insurance, considering the actual operation of medical insurance, it establish the index system of performance evaluation to strength the performance evaluation toward private insurance’ participation in management of social medical insurance.The feature and innovative points of the dissertation are followings:①Based on the study of private insurance’s participation in management of social insurance abroad and the domestic practice of private insurance’s participation in management of social insurance, it has designed the appropriate model of private insurance’s participation in major illness medical insurance and basic social medical insurance respectively. It believes the primary operation model of the major illness medical insurance is insurance contract operation model, meanwhile the primary one of the basic medical insurance is fund management operation model.②The dissertation establish systematic analytical index of performance evaluation for insurance contract operation model and fund management operation model, and provide quantitative found for social security department establishing the efficient motivation and commitment mechanism toward the participation of private insurance companies. |
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