商业健康险，为何缺席“医保法”？

Core Viewpoint - The draft of the Medical Security Law does not clearly reflect a multi-tiered medical security system, raising concerns among scholars about the future role of commercial health insurance in China's healthcare framework [1][2][11]. Legislative Context - The Medical Security Law draft was publicly released on June 27, 2023, and the public consultation period ended on July 27, 2023, after four years of legislative progress [2][3]. - The draft has passed preliminary review, but the specific implementation timeline is yet to be determined by the National People's Congress [3]. Commercial Health Insurance Concerns - The absence of commercial health insurance in the main body of the draft has led to worries about its development and future positioning within the multi-tiered medical security system [2][4]. - Commercial health insurance is only mentioned in the appendix of the draft, indicating its role as a supplementary rather than a core component of the medical security framework [5][6]. Multi-Tiered Medical Security System - The draft includes references to a multi-tiered medical security system, but it primarily focuses on basic medical insurance, supplementary medical insurance, and medical assistance, excluding commercial health insurance [7][9]. - The National Healthcare Security Administration has emphasized the importance of a "1+3+N" multi-tiered medical security system, where "N" represents various supplementary forms, including commercial health insurance [10]. Legislative Implications - Scholars argue that the lack of clear definitions and responsibilities for the multi-tiered medical security system in the draft could hinder its effectiveness [11][13]. - The draft's current positioning as a basic social security law suggests a strict separation between statutory medical insurance and commercial insurance [12][14]. Regional Legislative Initiatives - Various regions, such as Zhejiang and Shanghai, have already implemented local regulations that encourage the development of commercial health insurance, indicating a growing recognition of its role in the multi-tiered system [18][23]. - The Zhejiang Provincial Medical Security Regulation, enacted in 2021, has successfully integrated commercial health insurance into its healthcare framework, achieving a participation rate of over 50% for supplementary insurance [22]. Recommendations for Future Legislation - Experts suggest that the National Healthcare Security Administration should collaborate with financial regulatory authorities to create a top-level design for commercial health insurance, clarifying roles and responsibilities [25].