健康中国背景下健康管理在社会医疗保险中的应用

doi:10.6040/j.issn.1671-7554.0.2018.1050

摘要/Abstract

摘要： 党的十八届五中全会以来,“健康中国”上升为国家战略,对社会医疗保险的保障作用提出了新要求。同时,随着社会老龄化程度加剧,慢性病高发,医疗费用负担过重等问题越发突出,单纯以疾病治疗为目的、以费用报销为手段的社会医疗保险无法从根本上解决以上问题。因此,探讨了在社会医疗保险中引进健康管理以及社会保险和商业保险的合作模式,介绍了健康管理的预防作用,即通过控制参保人的疾病风险,提高基层卫生服务资源利用率,旨在促进社会医疗保险可持续发展。

关键词: 健康管理, 社会医疗保险, 应用, 商业保险, 结合

Abstract: Since the Fifth Plenum of the 18th Central Committee of the Communist Party of China, “Healthy China” has been promoted as a national strategy, and new requirements have been put forward for social medical insurance. At the same time, with the aggravation of the aging degree of society and high incidence of chronic diseases, the excessive burden of medical expenses has become more prominent. The above problems cannot be settled by social medical insurance, which only aims at the treatment of diseases and only takes expense reimbursement as the means. Therefore, this paper explored the application of health management in social medical insurance, the cooperation model of social insurance and commercial insurance,as well as the preventive role of health management(such as, controlling the disease risk of insured persons and improving the utilization rate of grassroots health service resources), in order to promote the sustainable development of social medical insurance.

Key words: Health management, Social medical insurance, Application, Commercial health insurance, Combination

中图分类号:

R197.1

巢健茜,蔡瑞雪. 健康中国背景下健康管理在社会医疗保险中的应用[J]. 山东大学学报 (医学版), 2019, 57(8): 53-60.

CHAO Jianqian, CAI Ruixue. Application of health management in social health insurance in the context of Healthy China[J]. Journal of Shandong University (Health Sciences), 2019, 57(8): 53-60.

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