CAJ | 학술논문

美国奥巴马政府自2010年通过平价医疗法案(ACA),对医疗保障体系实施了一系列改革措施.法律要求全民强制参保,但大多数保险项目仍由商业保险公司提供,因此,如何保证商业健康保险有效发挥社会保障功能就成为执行中的难题.为此,法律特别写明了一系列关于商业保险项目医疗赔付率(MLR)的规定,希望通过对其监控和规定,完善保险产品的公平定价机制,确保消费者权益.本文将对MLR规则的内容、影响进行系统分析,以期为我国商业健康保险监管政策提供经验借鉴.
미국오파마정부자2010년통과평개의요법안(ACA),대의료보장체계실시료일계렬개혁조시.법률요구전민강제삼보,단대다수보험항목잉유상업보험공사제공,인차,여하보증상업건강보험유효발휘사회보장공능취성위집행중적난제.위차,법률특별사명료일계렬관우상업보험항목의료배부솔(MLR)적규정,희망통과대기감공화규정,완선보험산품적공평정개궤제,학보소비자권익.본문장대MLR규칙적내용、영향진행계통분석,이기위아국상업건강보험감관정책제공경험차감.
ince the Affordable Care Act (ACA) was adopted in 2010, a serious reforms in health insurance system in the U.S. has been carried out. People are required to buy insurance, but it is still provided by private insurance companies. Therefore, how to make commercial health insurance play roles in social security has been an issue in the executing system. For this, the regulation has clarified Commercial Medical Insurance Compensating Rate to protect the consumer's benefit by monitoring and defining the compensating rate to promote a fair price forming mechanism. In this paper, we analyzed the contents and effects of medical insurance compensating rate to provide reference for monitoring policy on the commercial health insurance of China.