Zhang Liujin, Ma Wenwen, Zheng Chao, Song Jiling, Sun Qiang, Yin Jia
Center for Health Policy and Health Economics, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
Weihai City Health Commission, Weihai, 264200, China.
BMC Health Serv Res. 2025 May 19;25(1):717. doi: 10.1186/s12913-025-12886-4.
This study aims to quantitatively evaluate China's commercial health insurance (CHI) policies and provide a reference for improving the policy.
By means of the text mining and literature research method, the Policy Modeling Consistency Index (PMC-index) model of CHI policies was constructed. The model was used to analyze the 22 policies individually and as a whole to describe the current situation of CHI policies in China.
The PMC-index model consisted of 10 primary variables and 41 secondary variables. This study found that the average PMC index of the 22 policies included is 7.48, suggesting that existing policies are generally of high quality. Among them, good policies accounted for 18.18%, and excellent policies accounted for 81.82%. Among the primary variables, X10 (policy disclosure) had the highest score, and the scores of other primary variables were ranked as X3 (policy recipients) > X5 (policy content) > X6 (policy tools) > X8 (cooperation and connection) > X7 (content evaluation) > X1 (policy nature) > X9 (policy goals) > X4 (policy incentives) > X2 (policy timeliness).
At present, China's CHI policies are generally at an excellent level. However, there is still room for improvement with regard to "policy incentives, policy goals, content evaluation, policy tools and policy content". We recommend that policymakers optimize China's CHI policies by improving the policy incentive mechanism; balancing policy goals; clarifying task distribution; optimizing policy tool structure; and developing inclusive health insurance.
本研究旨在对中国商业健康保险（CHI）政策进行定量评估，为完善政策提供参考。
采用文本挖掘和文献研究方法，构建中国商业健康保险政策的政策建模一致性指数（PMC-index）模型。利用该模型对22项政策进行单独及整体分析，以描述中国商业健康保险政策的现状。
PMC-index模型由10个一级变量和41个二级变量组成。本研究发现，所纳入的22项政策的平均PMC指数为7.48，表明现有政策总体质量较高。其中，良好政策占18.18%，优秀政策占81.82%。在一级变量中，X10（政策公开）得分最高，其他一级变量得分排序为X3（政策受众）＞X5（政策内容）＞X6（政策工具）＞X8（合作与衔接）＞X7（内容评估）＞X1（政策性质）＞X9（政策目标）＞X4（政策激励）＞X2（政策时效性）。
目前，中国商业健康保险政策总体处于优秀水平。然而，在“政策激励、政策目标、内容评估、政策工具和政策内容”方面仍有提升空间。我们建议政策制定者通过完善政策激励机制；平衡政策目标；明确任务分配；优化政策工具结构；发展普惠型健康保险来优化中国商业健康保险政策。
