A Study On The Policies And Evaluation Index System Of Inclusive Commercial Health Insurance Based On The Cooperation Of Basic Medical Insurance And Commercial Health Insurance In China

Objectives: By sorting out the relevant policies of the integrated development of social medical insurance and commercial health insurance and describing the state of such things at home and abroad,as well as comparing and analyzing the business model and coverage of inclusive commercial health insurance in China,in order to figure out the main problems,and try to build an evaluation index system for the operation effect of this kind of insurance,and finally provide a reference for further improving medical protection level and assisting government departments in formulating appropriate management methods.Methods: We searched databases,government websites,and public websites to obtain information on inclusive commercial health insurance to conduct literature research then used comparative analysis to describe the current state of insurance operations from several aspects.Finally,we used the Delphi expert consultation method to construct an index system to evaluate the effectiveness of the implementation of this insurance.Results: As of early December 2021,the inclusive commercial health insurance has been launched in 27 provincial-level administrative regions and 103 cities in China.At present,there are 176 types of inclusive commercial health insurance products and194 insurance plans(different responsibilities of the same product are recorded as a new insurance plan)in the market.These products are mainly divided into "national" and "regional custom" types.Hospitalization expenses in the medical insurance catalog and specific high-cost drugs are the prominent coverage of this insurance.The insurance deductible for most products is 20,000 yuan.Most of the products are priced between 100-200 RMB,and the total reimbursement amount(cap line)is above one million,mainly between 1 million and 3 million.Most products still fall under the category of short-term medical insurance,and these products can be divided into three categories in terms of the degree of government involvement: governmentdirected,government-supported,and government-not-explicitly-involved.The involvement of underwriting institutions and third-party platforms has also influenced the development of these products.In addition,the results of the index system screening by the Delphi method showed that the positive coefficients of both rounds of correspondence exceeded 90%,and the expert authority coefficients(Cr)were more significant than 0.7.A set of operational effectiveness evaluation index systems consisting of 3 first-level indexes,7 second-level indicators,and 22 third-level indexes were finally determined by expert scoring.Conclusion: The integration development of basic medical insurance and commercial health insurance is in line with building a multi-level medical security system in China.The emergence of inclusive commercial health insurance has made a positive contribution to improving the multi-level medical security system and improving the overall medical security level in China.However,such insurance products still face many problems and challenges in the development process,requiring the relevant departments to respond actively.The evaluation index system constructed in this paper will also reference relevant departments to carry out project management.