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健康管理的成功与否是保险公司的健康保险利润的重要影响因素。当前,我国正处于医疗体制改革的关键时期,健康保险如何与医院开展有效的管理衔接,即“健康保险的健康管理”成为了一项复杂的管理工程。文章分析了我国健康保险业健康管理现状及其面临的问题,如竞争与选择不足、信息系统平台尚未建立、可能来自医疗服务提供方的阻力以及保险公司微观管理能力欠缺等,并提出了试行和逐步推广管理型医疗(保险)方案、积极筹建和完善网络信息平台、政府作为以及创新财务制度等政策建议。
The success or failure of health management is an important factor in insurance company’s health insurance profit. At present, our country is in the crucial period of the medical system reform. How the health insurance links with the hospital to carry out effective management means that “Health Insurance for Health Insurance” has become a complicated management project. This paper analyzes the status quo and problems faced by health insurance industry in our country, such as the lack of competition and selection, the information system platform has not been established, the possible resistance from medical service providers and the lack of micro-management ability of insurance companies, Gradually promote managed medical (insurance) programs, actively build and improve the network information platform, the government as well as innovative financial policies and other policy recommendations.