本文字数：3351字 阅读时间：7分钟 2025年第8辑目录 团体补充医疗保险改革视角下的医、药、险 摘要：澳大利亚是OECD国家中商业健康保险覆盖率最高的国家之一。为了维持高覆盖率，澳大利亚政 府实施一系列"胡萝卜加大棒"的政策，主要包括基于年龄和收入调整的保费退税（费）、终身健康保险 （Lifetime Health Cover）、医疗保险附加税（Medicare Levy Surcharge）、风险调整机制（Risk Equalisation）等。这些政策的实施避免了澳大利亚商业健康保险陷入"死亡螺旋"，对我国惠民保的可持 续发展具有借鉴意义。 墨西哥二元医保制度及整合策略 高质量协同发展路径 严霄 朱铭来 赵颖旭 王校复 张斯维 杜霞 摘要：当前，在深化医疗保障改革和医疗行业、医药产业高质量发展的多维驱动下，商业医疗保险面临 着巨大的发展机遇与挑战。本文深入分析我国以个人商业健康险市场为主的发展过程，认为个人商业健 康险市场的"逆选择"问题，是造成商业医疗保险陷入成本经营高、服务效率低、费控基础弱、覆盖人群 少等恶性循环的根本原因；通过比较研究七个典型国家或地区商业医疗保险的发展经验及共性规律，揭 示 ...

Group 1 - The core viewpoint of the article emphasizes the high-quality collaborative development between commercial health insurance and the pharmaceutical industry, highlighting the interdependent relationship between medical service providers and insurance payment entities [1] - The historical development of the medical service system and the pharmaceutical industry reveals a complex interplay with insurance payment mechanisms, indicating potential areas for collaboration and growth [1][2] - The transition from a government-subsidized healthcare model to a market-driven approach has led to significant changes in the operational dynamics of public hospitals and the pharmaceutical sector [3][4] Group 2 - The period from 2009 to 2017 marked a significant phase in the reform of public hospital compensation mechanisms, with a focus on balancing the roles of medical service providers and insurance payers [9][10] - The introduction of the "New Medical Reform" in 2009 aimed to establish a public health service system that covers urban and rural residents, although challenges in implementation persisted [9][14] - The commercial health insurance market experienced substantial growth during this period, with premiums increasing tenfold, reflecting a rising demand for supplementary health coverage [6][15] Group 3 - The establishment of the National Healthcare Security Administration in 2018 initiated a new phase of medical reform, introducing diverse payment methods and enhancing regulatory oversight of healthcare expenditures [20][21] - The shift towards a more refined management approach in healthcare institutions is driven by the need to control costs and improve service quality, influenced by changes in insurance payment structures [23][24] - The integration of commercial health insurance with the healthcare system is expected to accelerate, particularly in the high-end medical service sector, as consumer demand for quality healthcare rises [26][27] Group 4 - The pharmaceutical industry in China has undergone significant transformations, with a notable shift towards biopharmaceuticals and innovative drug development, supported by government policies [30][31] - The rapid growth of the Chinese pharmaceutical market has positioned it as the second-largest globally, with a compound annual growth rate of 7.8% from 2010 to 2020 [31][33] - Despite the overall market expansion, challenges such as structural oversupply and the need for higher-quality products remain prevalent, necessitating ongoing industry adjustments [33][34]