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医疗费用与医疗保险损失水平是商业医疗保险经营和社会医疗计划管理的基础。本文利用权威部门公布的信息、检索专题研究的文献和分析专题调查数据三类方法系统地研究了沪蓉两地医疗费用与医疗保险损失的真实水平,发现上海的医疗费用和医疗保险损失水平显著高于成都,约为后者的2倍。在分析造成沪蓉两地医疗费用与医疗保险损失水平差异可能原因的基础上讨论了上述发现对健康保险精算实践、商业医疗保险产品及社会医疗保险计划设计和管理上的启示与指导价值。
Medical costs and the level of health insurance losses are the basis for the management of commercial health insurance and social health programs. This article systematically studied the actual level of medical expenses and medical insurance losses in Shanghai and Chengdu using the information published by authoritative departments, searching the literature of the thematic studies and analyzing the special survey data, and found that the level of medical expenses and medical insurance losses in Shanghai was significant Higher than Chengdu, about the latter 2 times. Based on the analysis of the possible causes of the difference between the medical expenses and medical insurance losses in Shanghai and Chengdu, the findings and implications of the above findings on the actuarial practice of health insurance, the design and management of commercial medical insurance products and social medical insurance plans are discussed.