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中国居民大病医疗保险以政府购买服务的方式委托商业保险经办。服务外包是破解公共服务供给难题的可行途径,但实现成本平衡是公共服务外包的关键问题。医疗保险服务外包的成本补偿方式有管理费制和保费制两种模式。管理费制下,商业保险不承担医疗保险基金风险,通过测算人工成本与物质成本,较容易实现成本平衡。保费制下,由于参保人群风险水平高,医疗保险费用报销成本高于保费收入,商业保险普遍面临成本覆盖困难的问题。为此,政府需要完善公共服务外包中购买服务的成本预算、谈判机制和协议管理体制,从而强化政府责任、转变政府职能。
Chinese residents seriously ill medical insurance commissioned by the government to purchase commercial insurance business approach. Service outsourcing is a feasible way to solve the supply problem of public service, but realizing cost balance is the key issue of public service outsourcing. Medical insurance service outsourcing cost compensation methods are the management fee system and premium system in two modes. Management fees, commercial insurance does not assume the risk of medical insurance funds, by measuring the cost of labor and material costs, easier to achieve cost-balanced. Under the premium system, due to the high risk level of insured persons and the higher reimbursement cost of medical insurance expenses than premium income, commercial insurance generally faces the problem of difficult cost coverage. To this end, the government needs to improve the cost budget, negotiation mechanism and agreement management system of purchasing services in public service outsourcing so as to strengthen government responsibility and transform government functions.