我国儿童商业医疗保险发展研究

发布时间：2018-06-07 11:32

本文选题：儿童 + 医疗保险　；参考：《西南财经大学》2013年硕士论文

【摘要】：我国现有3.67亿(近4亿)的少年儿童,他们当前基本上处于医疗保障水平低或无医疗保障状态,其中数量达到2.6亿的介于0到6岁间的儿童,他们没有任何医疗保险,且每年以1200万的数量在增加。而有关资料显示,我国5岁以下的儿童,其死亡人数每年居然达到40万,由于无法获得及时治疗而造成死亡的人数,数量甚至达到了24万之高,换句话说,每年死亡的孩子中,本有60%孩子原可免于死亡,这个数字的巨大足以引起我们的反思。我国儿童商业医疗保险仍然是商业医疗保险的薄弱环节,特别是儿童易发重大疾病救治得不到足够的经济上的支持和补偿,发展我国商业儿童医疗保险势在必行。这里将从我国儿童医疗保险保障现状及问题入手,首先分析我国儿童社会医疗保险情况,同时加入对我国商业儿童医疗保险存在缺陷的考虑,并指出我国政府对儿童商业医疗险支持疲软,得出要发展我国儿童商业医疗保险的结论。然后再对我国儿童商业医疗保险发展困难的原因进行讨论。最终,分析我国儿童商业医疗保险消费者市场需求状况,并为商业儿童医疗保险从政府行业组织、保险公司以及消费者角度,给出相应的发展建议。本文内容分为四个部分：第一部分是绪论部分：主要阐述了选题的研究背景及意义,并对研究目的和方法做了简要提及。第二部分全面描述医疗保险,点出医疗保险的特点。对儿童医疗保险被保险人做出界定,阐述儿童医疗险区别于成人险的特别之处,并进行深入分析,使读者掌握决定儿童医疗险需求的因素和儿童疾病意外风险的特征。最终阐明发展商业儿童医疗保险的意义。第三部分是我国儿童医疗保险现状问题及成因：此章节的目的是为了说明发展儿童商业医疗保险的必要性,从社会保险和商业保险两个方向出发阐明我国儿童医疗保险现状问题。文章先阐述了我国儿童医疗保障在社会保险领域的表现。首先,我国儿童社会医疗保险普及度仍然不高,城镇儿童社会医保普及度比农村儿童还要低。再来就是,已建立儿童社会医保制度的地区为儿童提供的医疗保障水平低。综合可得出结论,我国的儿童基本医疗保障体系不能提供能够基本上满足儿童医疗保障需求的服务。接着又表述了我国儿童商业医疗保险现状问题。我国商业保险市场上的儿童医疗保险产品虽然数量繁多,但险种种类偏少,且现有的几种中同质性问题和保障不足的问题同样存在。章节的最后部分给出我国儿童商业医疗保险发展不如人意的原因,究其原因主要包括： (一)保险公司方面。儿童医疗保险在设计之初就已经偏离了市场的需求,这是由保险产品的特殊性以及设计者忽视未成年人的保险需求共同决定的。并且由于儿童医疗保险产品具有的区别于其他产品的特性(医疗机构的参与和投保人的独立性)使其产品风险更为复杂,增加了产品开发的难度。最后,市场上提供的产品与少儿医保功能的重合也是儿童商业医疗保险产品存在问题的重要表现。 (二)投保人方面。健康险产品市场意愿强烈、实际购买不足,并且儿童产品需求在整个需求中更为滞后,也在一定程度上阻碍了我国商业儿童医疗险的发展。 (三)医疗机构方面。对经济利益的追逐是这方面阻碍儿童商业医疗险发展的元凶。而保险三方行为主体间信息不对称和医疗机构从业人员的权责不对称为经济利益追逐过程中的医疗费用欺诈和过度消费行为提供了生长发育的土壤。(四)政府方面。现有的儿童医疗保障相关规章中只对社保做出了规范,而缺乏对商保的规范限制。而为促进商业健康险发展的一系列规章制度也没有对儿童领域做出额外的指导管理。所以,从中可以看出儿童商业医疗保险缺乏政策的规范和支持。由儿童医疗保障在社保和商保中的表现可以得出我国发展商业儿童医疗保险的必要性。第四部分是我国儿童商业医疗保险的发展及建议：这部分内容先是对我国儿童医疗保险保障需求进行分析,目的是为了说明发展的可能性。从我国人民对健康险购买意愿强烈,我国儿童基数大、医疗费用支出高,儿童死亡率、发病率高几方面得出我国商业儿童医疗险职能的缺失,有很大的发展空间。最后又从儿童商业医疗保险得到发展后的直接受益方(政府、保险公司以及社会群众)的立场出发为促进儿童商业医疗险的发展给出了建议。依据已收集的文献,前人对于此选题并没有太深入的研究,本文在前人提出的基础观点之上,深入分析了影响投保人购买儿童医疗险意愿的因素,并对我国儿童商业医疗保险的现状问题做出较为的精确总结,给出造成此问题的原因。最后从保险公司、政府行业组织、社会群众角度为我国儿童商业医疗保险的发展给出建议,其中与儿童医疗行为有关的疾病进一步细化、城乡生活习性差异等因素对保险的影响在现有文件较少涉及,希望能够为以后相关课题的研究提供一定的帮助。
[Abstract]:There are 367 million (nearly 400 million) children in our country. They are currently in a state of low or no medical security, of which 260 million of children are between 0 and 6 years old. They have no medical insurance and an increase of 12 million per year. The data show that children under 5 years of age in China are dead. The number of people actually reached 400 thousand per year, and the number of deaths caused by the inability to get timely treatment was even up to 240 thousand. In other words, 60% of the children died every year. The number was huge enough to cause us to reflect. China's children's commercial medical insurance is still a commercial medical insurance. It is imperative to develop the medical insurance of our country's commercial children. This will start with the status and problems of China's children's medical insurance, and first analyze the situation of the social medical insurance for children in our country, and join the medical care of our country's commercial children. The reasons for the weakness of the insurance for children's commercial medical insurance are pointed out, and the conclusion of the development of China's children's commercial medical insurance is concluded. Then, the reasons for the difficulties in the development of China's children's commercial medical insurance are discussed. Finally, the demand for the consumer market of the children's commercial medical insurance in China is analyzed and the commercial medical insurance of our country is analyzed. Medical insurance for children from the perspective of government industry organizations, insurance companies and consumers, gives corresponding suggestions for development.
The content of this article is divided into four parts: the first part is the introduction part: it mainly expounds the research background and significance of the topic, and gives a brief reference to the purpose and method of the research.
The second part describes the medical insurance and points out the characteristics of the medical insurance. It defines the insured of children's medical insurance, expounds the special features of the children's medical insurance area, and carries out an in-depth analysis to make the readers master the factors that determine the needs of the children's medical insurance and the characteristics of the children's disease risk. Finally, the developer will clarify the developer. The significance of medical insurance for children.
The third part is the problems and causes of China's children's medical insurance. The purpose of this chapter is to illustrate the necessity of developing children's commercial medical insurance. From the two directions of social insurance and commercial insurance, the problem of the status of China's children's medical insurance is clarified.
First, the popularity of children's social medical insurance is still low, and the popularity of urban children's social medical insurance is lower than that of rural children. In the meantime, the level of medical security provided for children has been low. The conclusion is that our children's basic medical insurance system can not provide services that basically meet the needs of children's medical security.
Then the current situation of China's children's commercial medical insurance is expressed. Although there are a wide range of children's medical insurance products in the commercial insurance market in China, there are few types of insurance, and the existing problems of medium homogeneity and insufficient guarantee are also existing.
The last part of the chapter gives the reasons why children's commercial medical insurance is not well developed in China.
(1) in the insurance company, children's medical insurance has deviated from the market demand at the beginning of the design, which is determined by the particularity of the insurance products and the designer's neglect of the insurance needs of the minors. And because the children's medical insurance products are different from other products (the participation and the insured of the medical institutions) The independence of the products makes the product risk more complex and increases the difficulty of product development. Finally, the reintegration of the products and children's medical insurance function on the market is also an important manifestation of the problems of the children's commercial medical insurance products.
(two) the policy holder. The health insurance product market is strong, the actual purchase is insufficient, and the demand for children's products is lagging behind in the whole demand, and it has also hindered the development of Chinese commercial children's medical insurance to some extent.
(three) the pursuit of economic interests is the main obstacle to the development of children's commercial medical insurance. The asymmetric information between the three parties of the insurance and the asymmetric power and responsibility of the employees of the medical institutions provide the growth and development soil for the medical expense fraud and the excessive consumption behavior in the process of economic interest pursuit. Four) on the government side, the existing regulations on children's medical security are only standardized for social security and lack of standard restrictions on commercial insurance. And a series of rules and regulations to promote the development of commercial health insurance have not made additional guidance to the field of children. Therefore, it can be seen that the lack of policy for children's commercial medical insurance is a rule. Fan and support.
The necessity of developing medical insurance for commercial children can be concluded from the performance of child health care in social security and commercial insurance.
The fourth part is the development and suggestion of China's children's commercial medical insurance: this part is first to analyze the needs of China's children's medical insurance. The purpose is to explain the possibility of development. From the strong willingness of the people to buy health insurance, the basic number of children in our country is large, the cost of medical expenses is high, the mortality rate of children is high and the incidence is high. Several aspects of China's commercial children's medical insurance function missing, there is great room for development.
Finally, from the standpoint of the direct beneficiaries (government, insurance companies and the social masses) after the development of children's commercial medical insurance, some suggestions are given to promote the development of children's commercial medical insurance.
On the basis of the collected literature, the predecessors have not studied this topic too deeply. On the basis of the basic viewpoints of the predecessors, this paper deeply analyzes the factors affecting the willingness of the insured to buy children's medical insurance, and makes a more accurate summary of the problems of the current situation of China's children's commercial medical insurance, and gives the reasons for the problem. Then from the insurance company, the government industry organization, the social point of view for the development of China's children's commercial medical insurance, the development of China's children's commercial medical insurance is given some suggestions, in which the disease related to children's medical behavior is further refined, the difference of living habits and other factors of urban and rural habits on insurance is less involved in the existing documents, hoping to provide a research for future related topics. A definite help.
【学位授予单位】：西南财经大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

【参考文献】