缓解群众就医困难，防止因病致贫、因病返贫，持续提高医疗保障水平是我国医疗保障体系建设的工作重点。为解决医疗保障体系发展中的失衡问题，提高医疗保险的覆盖水平，各地纷纷推出了城市定制型商业医疗保险——惠民保来补充当地基本医疗保险和商业重疾险之间的空白。但由于惠民保产品发展时间较短，发展速度过快，出现了定位不清晰、保障效果不理想等问题，极大的影响了惠民保的可持续发展。因此研究其保障效果、保障水平以及面临的问题，能给现有惠民保产品的修正、新产品的设计提供参考价值，对推动普惠健康保险良好发展、完善我国医疗保障体系、塑造健康中国等具有重大意义。

本文以普惠金融、保险中介理论、金融排斥与保险排斥理论为理论基础，结合现有的研究文献分析我国惠民保的发展情况。明确了惠民保的定位，同时整理了国内全部的205款惠民保产品，分析总结了惠民保产品的现状、产品特点及可持续发展情况。在此基础上从惠民保承保情况、参保情况、保障责任情况和服务情况四个层面选取19个指标，运用因子分析模型对这些产品的保障效果进行分析并选取6款产品详细对比。最后选取西安市某三甲医院的肿瘤外科病人治疗费用作为样本数据，探讨惠秦保在重大疾病上的保障效果。通过上述方法从不同方面对惠民保的保障效果进行分析。

在对惠民保进行多方面分析后，本文得到了如下结果：1、保障效果较好的惠民保产品具备的公共特征为获得政府支持、平均保费偏高、保额上限报销比例和特药数量都明显较高、罕见病理赔和既往症理赔明显出色、包含的保证责任范围更加全面。此外惠秦保对肿瘤患者的赔付条件要求很高，覆盖的人数占比很少，随着肿瘤患者住院费用的增加，惠秦保的保障效果越来越明显；2、惠民保目前存在的问题主要表现为免赔额设定较高、产品良莠不齐、保证责任范围有限、产品渗透率较低、无法保证续保；3、惠民保发展趋势表现出短期内仍然保持高的铺开趋势、出现参保率界限、惠民保产品不再局限在单一定价中、保险公司将继续维持保费收支平衡状态等现象。本文对惠民保产品的保障效果进行了全面的分析，并针对上述研究结果从可持续性和普惠性出发，站在保险公司、当地政府部门和监管部门的角度上给出惠民保产品未来的发展建议。

The creation of China's medical insurance system is centered on easing public access issues, preventing illness-related poverty, returning to illness-related poverty, and steadily raising the level of medical insurance. Urban customized commercial medical insurance, Huimin Insurance, has been introduced nationally to fill the gap between local basic medical insurance and commercial critical illness insurance in order to address the imbalance in the development of the medical security system and increase the level of medical insurance coverage. The rapid and brief growth of Huimin insurance products has, however, led to issues including ambiguous positioning and inadequate coverage that have a significant negative impact on the long-term viability of Huimin insurance. In order to improve China's medical security system, advance universal health insurance, and create a healthy China, it is crucial to study the coverage effect, coverage level, and problems encountered in order to provide reference data for the revision of current beneficiary insurance products and the design of new products.

 

This paper examines the growth of Huimin Insurance in China using the body of research literature and bases its analysis on theories of inclusive finance, insurance intermediary theory, financial exclusion, and insurance exclusion theory. Clarification of Huimin Insurance's posture is provided, along with a compilation of all 205 domestic Huimin Insurance products and analyses and summaries of their current state, product features, and prospects for sustainable growth. Based on this, 19 indicators from underwriting, participation, liability, and service levels were chosen, and a factor analysis model was used to evaluate the efficacy of these goods. Six products were then chosen for in-depth comparison. In order to investigate the coverage impact of Huiqin Insurance on significant diseases, this paper chose the treatment costs of surgical cancer patients in a tertiary hospital in Xi'an as the sample data. The efficiency of Huimin Insurance's coverage was examined from various angles.

 

The following conclusions were reached after this paper examined several features of Huimin Insurance: 1. The public features of Huimin Insurance products with better coverage include government support, high average premiums, a noticeably higher reimbursement ratio of the coverage cap and number of specialty drugs, noticeably better claims for rare diseases and prior illnesses, and more thorough coverage of guaranteed liability. Huiqin Insurance also only covers a limited portion of the population and has strict compensation standards for cancer patients. The security provided by Huiqin Insurance is becoming increasingly clear as healthcare expenses for cancer patients rise. 2. Huimin Insurance currently has a number of issues, including a high deductible setting, inconsistent product quality, a narrow assurance of responsibility, low market penetration, and an inability to guarantee renewal. 3. Huimin Insurance's development trend indicates that the rollout trend will likely continue to be strong in the near future, that participation rate boundaries are beginning to emerge, that Huimin insurance products are no longer constrained by single pricing, and that the insurance companies will continue to operate at break-even premium levels. This paper presents a comprehensive analysis of the protection effects of Huimin insurance products and gives suggestions for the future development of Huimin insurance products from the perspectives of insurance companies, local government departments, and regulatory authorities in light of the above findings in terms of sustainability and universality.

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