《保险研究》20241207-《国家责任转变中普惠型商业医疗保险的公私合作模式研究》（康雷闪、雷祖发）

［摘   要］普惠型商业医疗保险作为多层次医疗保障体系中的重要一环，其可持续发展的关键在于如何融入多元性、开放性及协同性的公私合作交互关系中。我国现有国家管制责任下的政府指导模式、国家给付责任下的政府主导模式及国家服务责任下的政府推动模式，暴露出规范主义下普惠与商业法益保护的失衡、功能主义下公私协同保险参与治理的失效以及保险权责界限模糊导致公私法监管混乱的问题。在国家责任转变视野下，国家担保责任作为公私合作领域的新兴国家责任理论，对于解决普惠型商业医疗保险领域的公私合作难题，有着天然的理论优势。在国家担保责任理论下，普惠型商业医疗保险的公私合作模式建立在公私角色定位的基本立场上，依托公私共治方式之转型为路径，以公私权责之合理配置强化法律保障，实现“普惠”和“商业”的融合共生。

［关键词］国家责任转变；普惠型商业医疗保险；公私合作；国家担保责任；社会治理

［基金项目］ 本文系国家社科基金项目“老龄化背景下第三支柱商业养老保险法律保障机制研究”(22BFX119)的阶段性成果。

［作者简介］康雷闪，中国石油大学(华东)文法学院副教授，研究方向：保险法学；雷祖发，中国石油大学(华东)文法学院硕士研究生，研究方向：保险法学。

A Study on Public-Private Partnership Model for Inclusive Commercial Medical Insurance in the State Responsibility Transformation

KANG Lei-shan,LEI Zu-fa

Abstract：Inclusive commercial medical insurance,as a vital component of the multi-tiered medical security system,hinges on integrating into diverse,open,and collaborative public-private partnership (PPP) interactions for its sustainable development.Existing models in China,including the government-guided model under national regulatory responsibility,the government-led model under national payment responsibility,and the government-promoted model under national service responsibility,have exposed issues such as an imbalance between inclusiveness and commercial legal interest protection under normativism,failures in public-private collaborative insurance governance under functionalism,and confusion in public-private law regulation due to ambiguous boundaries of insurance rights and responsibilities.From the perspective of the transformation of state responsibility,the state guarantee responsibility,as an emerging theory of state responsibility in the field of PPP,naturally possesses theoretical advantages for addressing PPP challenges in inclusive commercial medical insurance.Under this theory,PPP in inclusive commercial medical insurance is built on the fundamental stance of defining public and private roles,relying on the transformation of public-private co-governance as the path,and strengthening legal safeguards through the rational allocation of public and private rights and responsibilities to achieve the symbiotic integration of “inclusiveness” and “commerciality.”

Key words：transforming state responsibility;inclusive commercial medical insurance;public-private partnership;national guarantee responsibility;social governance