《保险研究》20241206-《医疗保险参保人信息发掘、共享的处理规则——以社会法权利保护理念为指导》（王逸伦）

［摘   要］为打破“数据孤岛”，《医疗保障法(征求意见稿)》及各地现行医疗保障条例和相关制度文件均提出应大力推动医保数据有效发掘与共享。然而，从信息流通与隐私保护的法律层面分析，我国《个人信息保护法》仅针对个体信息，其第13条列举的允许数据处理的情形难以应对医疗保险参保人信息发掘与共享的需要。传统的基于个人与数据处理方的二元责任结构，以及简单对立或统一个体利益与公共利益的二元理念，都难以直接应用于医保信息领域。在个体利益与公共利益之外，医疗保险参保人信息还涉及一种独立的利益范畴——集体性利益。未来立法可以尝试以社会法权利保护理念为指导，构建基于个人、参保人团体与数据处理方的三元责任结构，制定有关团体信息与隐私处理的规则。在多层次保险体系中实现信息的分层共享，可以更好地服务参保人员，提升全体参保人的福祉。

［关键词］医疗保障法；参保人信息；集体性利益；数据共享；团体隐私

［作者简介］王逸伦，中国政法大学民商经济法学院博士研究生。

Processing Rules for Sharing and Processing Social Medical Insurance Participant Information—Guided by Social Law Right Protection Concept

WANG Yi-lun

Abstract：In order to break the “data silos,the”Medical Security Law ( For Comments)”and current medical security regulations,along with related institutional documents at the local level,emphasize the need to promote the effective utilization and sharing of social medical insurance data.However,from the perspective of information flow and privacy protection laws,China’s Personal Information Protection Law focuses solely on individual data.Its Article 13,which lists permissible data processing scenarios,fails to meet the practical needs of exploring and sharing social medical insurance participant data.The conventional dualistic framework of protecting individual interests against data processors,along with the binary view of individual and public interests,proves difficult to directly apply to the context of social medical insurance information.Beyond individual and public interests,social medical insurance participant data involves an independent category of interest:collective interests.Future legislation could adopt the social law rights protection framework to establish a tripartite responsibility structure encompassing individuals,insured groups,and data processors.This would involve formulating rules for processing collective information and privacy.By implementing stratified data-sharing mechanisms within a multi-level insurance system,this approach could better serve insured individuals and enhance the welfare of all participants.

Key words：Medical Security Law;the insured information;collective interest;data sharing;group privacy