CAJ | 학술논문

我国医疗保险要提高整体保障水平，受到人口老龄化进程加快、慢性病呈高发态势和商业健康保险低水平发展的制约。健康管理是应对这些问题的有效之策，它可以控制医疗保险基金支出，提高商业健康保险机构的市场竞争力，降低商业健康保险机构的运营风险。允许医疗保险机构使用城乡居民健康档案信息是健康管理在医疗保险中得以应用的基础。社会医疗保险中应用健康管理可以从对参保(合)人员定期体检入手以对疾病早发现早干预，将慢性病患者的治疗和基层卫生服务相结合来开展，同时由基层卫生服务机构有针对性地开展健康教育和健康干预；商业健康保险中应用健康管理，除“外包模式”外，亟待相关部门出台实施细则以推动“自营模式”和“共建模式”。
아국의료보험요제고정체보장수평，수도인구노령화진정가쾌、만성병정고발태세화상업건강보험저수평발전적제약。건강관리시응대저사문제적유효지책，타가이공제의료보험기금지출，제고상업건강보험궤구적시장경쟁력，강저상업건강보험궤구적운영풍험。윤허의료보험궤구사용성향거민건강당안신식시건강관리재의료보험중득이응용적기출。사회의료보험중응용건강관리가이종대삼보(합)인원정기체검입수이대질병조발현조간예，장만성병환자적치료화기층위생복무상결합래개전，동시유기층위생복무궤구유침대성지개전건강교육화건강간예；상업건강보험중응용건강관리，제“외포모식”외，극대상관부문출태실시세칙이추동“자영모식”화“공건모식”。
The overall development of medical insurance in China is restricted by the rapid aging of population, the high incidence of chronic diseases and the low level of commercial health insurance. Health management may be the effective way to solve these problems since it can control the medical insurance expenditures, improve the market competitiveness of commercial medical insurance companies and reduce their operational risks. However, the application of health management in the social medical insurance lies in the shared health records of urban and rural residents among the medical insurance organizations. In the social medical insurance, health manage-ment is helpful to the early diagnosis and intervention via the regular checkup of the insured. This can be imple-mented by means of combining the treatment of patients with the chronic diseases and the primary health serv-ices, and meantime launching the targeted health education and intervention by the primary health service insti-tutions. The application of health management in the commercial health insurance, besides the“outsourcing pat-tern”, urgently requires that the relevant departments put forward the implementing rules so as to promote the“self-supporting pattern” and “cooperation pattern”.