摘要：随着我国医疗体制的改革和完善，市场对医疗保险的需求日益增大，商业医疗保险和社会医疗保险正逐步成为我国医疗保障体系的重要组成部分。特别是商业医疗保险在满足人民群众日益增长的健康保障需求，促进国民经济发展和社会稳定方面显示出越来越重要的作用。然而由于商业医疗保险的风险是客观存在的，使得我国商业医疗保险的发展处于一个瓶颈。为了使我国的商业医疗保险健康发展，就必须对我国商业医疗保险存在的风险加以分析，并针对问题采取有效的措施。
本文以商业医疗保险的风险为核心，综合运用保险、经济学等理论与方法，采取理论与实际相结合，通过分析商业医疗保险目前的现状以及存在的风险，得到以下观点：我国在宏观、微观这两个方面对我国商业医疗保险的发展具有影响；宏观上，我国的相关政策影响着商业医疗保险，例如相关法律，社会保障体系，医疗卫生服务体制等；微观上，商业保险公司在核保、核赔等方面增加一定的风险控制，并可以针对不同的发展阶段采取不同的策略。
关键词：商业医疗保险 风险 风险控制
Abstract: With the reformation and improvement of healthcare system in our country, growing demand for medical insurance appears in the market. As a result, commercial healthcare insurance and social health insurance become important parts gradually of medical security system in China. Especially, commercial healthcare insurance plays more and more important role in meeting people’s increasing demand for health security, promoting the development of national economy as well as maintaining social stability. However, it is a objective fact that risks exist in commercial healthcare insurance. So ,the development of commercial healthcare insurance is in a rather difficult condition at present .To make sure that commercial healthcare insurance can develop correctly and quickly in the future ,it is essential to analyze the risks which exists in commercial healthcare insurance and take measures to deal with these risks pertinently.
The article centers on the risks of commercial healthcare insurance. By comprehensively utilizing theories and methodologies of insurance and economics, combining theory and practice and analyzing the status quo of and existing risks and current commercial healthcare insurance, the article concludes the following: In both macro and micro aspects, our country has influence on the development of commercial healthcare insurance. On the one side, at the macro level, the relevant policies governments formulated affects commercial healthcare insurance, such as relevant laws, social security system, medical and healthcare system and so on. On the other, at the micro level, commercial insurance companies can control the risks of underwriting and claims assessment in a appropriate way and make proper strategies in different stages of development.
Key words: commercial medical insurance risk risk control
