The Research On Cooperation Between Social Medical Insurance And Commercial Insurance

Due to the economic development,the aging of population and other reasons,simply relying on basic medical insurance has been unable to meet people's the growing demand for health care services.This paper focuses on the cooperation of social medical insurance and commercial insurance to solve the problem of "difficult medical treatment and expensive medical treatment".We will focus on the social medical insurance how to cooperate with commercial insurance.This article first sheds light on the feasibility and the necessity of cooperation between social medical insurance and commercial insurance,through the cooperative governance theory and risk sharing theory,to evaluate health security system of social medical insurance and commercial insurance cooperation.Based on the practice of Luoyang,Zhanjiang,Taicang summarizes the current China's three kinds of social medical insurance and commercial insurance cooperation pattern,and through the comparison of three modes of social insurance and commercial insurance cooperation possible path:insurance contract mode suitable for serious illness insurance,and basic medical insurance agency to entrust mode.In M city social medical insurance cooperate with commercial insurance for more than 20 years,and the model is known as "M city model".Through the analysis of the social medical insurance and commercial insurance cooperation,and comparing with the cooperation of Luoyang,Zhanjiang,Taicang three patterns,get the evaluation of M city's social insurance and commercial cooperation policy,process and effect.It is found that the cooperative mode of social medical insurance and commercial insurance in M city has the advantages and characteristics as the combination of various cooperative modes,low-margin and risk sharing,real-time settlement through system co-construction and Co-governance of multi-departments.At the same time,there are many shortcomings as differences in medical insurance treatment among workers and residents,lack of cooperative performance evaluation system and supervisors.The shortcomings of the government in the management of public-private cooperation are due to the inadequacy of the management ability and the unclear concept of public-private cooperation.It is suggested that M city should start with changing the concept of medical security,expanding the right of commercial insurance,building on evaluation and supervision mechanism of cooperation,and the strengthening of the health insurance system,to improve the cooperation between social medical insurance and commercial insurance in M city.