重庆理工大学
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日期：2021年 12月 20日
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摘要
摘要
目前商业医疗保险是保险公司发挥风险保障和风险管理功能的重要体现，对保险
业参与民生保障发挥了重要作用。2014年 8月，国务院发布了《关于加快发展现代
保险业服务的若干意见》（简称“国十条”），将发展多样化的健康保险服务提到首
位，鼓励各家保险公司开发商业健康保险产品。同年，国务院发布了《关于加快发展
健康保险的若干意见》，此次通知是首次用专项文件提及商业医疗保险的发展，文件
中多次提及商业医疗保险对促进经济提质增效的作用。2015年 12月，全国首家互联
网医院——乌镇互联网医院实现在线诊疗，至此，打开了“互联网+商业医疗保险”
发展模式。在此背景下，R财险基层公司也开启了“互联网+”商业医疗保险的模式。
本论文对该公司发展商业医疗保险过程中存在的问题进行分析，并提出有针对性地建
议。
本文以 R财险基层公司为研究对象，在阅读了大量国内外关于商业医疗保险和
“互联网+”的文献后，针对目前 R财险公司发展商业医疗保险的状况和问题对所有
员工和部分客户进行了问卷调查，通过分析发现目前 R财险公司商业医疗保险创新
不够、客户健康管理水平有待提高、核心业务发展缓慢和线上线下结合不够。结合对
R财险公司的 SWOT模型分析及国外发达国家的经验启示，为 R财险基层公司提出
适合的“互联网+”健康商业医疗保险模式优化的建议：积极发展核心优势业务，创
新盈利模式，创新 AI诊疗系统，与公共医疗进行有效整合，改善运营模式，强化人
才队伍建设，整合医疗机构信息进行风险识别和管控等，这对于本行业的企业有一定
的借鉴意义。
关键词：商业医疗保险；互联网+；发展路径优化；SWOT
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Abstract
Abstract
At present, commercial medical insurance is an important embodiment of the risk
protection and risk management functions of insurance companies, and plays an important
role in the insurance industry's participation in people's livelihood security. In August 2014,
The State Council issued several Opinions on Accelerating the Development of Modern
Insurance Services (referred to as the "State Ten"), giving priority to the development of
diversified health insurance services and encouraging insurance companies to develop
commercial health insurance products. In the same year, The State Council issued several
Opinions on Accelerating the Development of Health Insurance. This notice is the first
time to mention the development of commercial medical insurance in a special document,
which repeatedly mentions the role of commercial medical insurance in improving the
quality and efficiency of the economy. In December 2015, Wuzhen Internet Hospital, the
first Internet hospital in China, realized online diagnosis and treatment, thus opening the
development mode of "Internet + commercial medical insurance". In this context, the basic
company of R Property Insurance also started the mode of "Internet +" commercial
medical insurance. This paper analyzes the problems existing in the process of the
company's development of commercial medical insurance, and puts forward targeted
suggestions.
This paper takes the basic company of R property insurance as the research object.
After reading a large number of domestic and foreign literature on commercial medical
insurance and "Internet +", it conducts a questionnaire survey on all employees and some
customers in view of the current situation and problems of R property Insurance company
developing commercial medical insurance. Through the analysis, it is found that R
property insurance company's commercial medical insurance innovation is not enough,
customer health management level needs to be improved, core business development is
slow and the combination of online and offline is not enough. Based on the SWOT model
analysis of R Property insurance Company and the experience and enlightenment of
foreign developed countries, suggestions are put forward for R property insurance
grass-roots companies to optimize the "Internet +" health commercial medical insurance
model: Actively develop core business advantages, innovate profit model, innovate AI
diagnosis and treatment system, effectively integrate with public medical treatment,
III
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