数字金融对“沪惠保”发展的影响研究

Research on the Impact of Digital Finance on the Development of “Hu Huibao”

摘要: 健康中国战略旨在全面提高全民健康水平，推动医疗卫生服务体系完善与健康产业繁荣，为民众提供全方位健康服务。在此背景下，商业医疗保险作为医疗保障体系的重要补充正快速发展，在填补保障空白、增强风险抵御能力、促进资源合理配置等方面发挥关键作用。“沪惠保”作为上海市政府指导下的首款城市定制型商业补充医疗保险，于2021年4月推出后备受关注。其亲民价格、高额保障和广泛覆盖，成为基本医保参保人员的重要保障选项，不仅提供额外医疗费用补偿，缓解经济压力，还通过健康管理服务提升市民健康意识，增强医疗保障体系韧性。数字金融为“沪惠保”注入新动能，移动支付、大数据分析、区块链技术等实现参保流程线上化、理赔服务智能化和风险管理精准化，扩大覆盖面，优化保费结构，体现普惠金融的包容性与创新性。然而，“沪惠保”推广中也面临问题：如何优化数字理赔流程、利用大数据设计个性化产品、平衡数据共享与隐私保护等。本文旨在全面剖析“沪惠保”发展现状，分析在数字金融影响下如何继续发展，并展望其未来方向。

Abstract: The Healthy China strategy aims to comprehensively improve the overall health of the people, promote the refinement of the medical and health service system, foster the prosperity of the health industry, and provide comprehensive health services to the public. Against this backdrop, commercial medical insurance, as an important supplement to the medical security system, is experiencing rapid development and plays a crucial role in filling coverage gaps, enhancing risk resilience, and facilitating the rational allocation of resources. “Hu Huibao”, the first city-customized commercial supplementary medical insurance program under the guidance of the Shanghai Municipal Government, has garnered significant attention since its launch in April 2021. With its affordable pricing, high coverage limits, and broad accessibility, it has become a vital option for basic medical insurance participants, offering additional medical expense compensation to alleviate financial burdens and enhancing public health awareness through health management services, thereby strengthening the resilience of the medical security system. Digital finance has injected new vitality into “Hu Huibao”, enabling online enrollment processes, intelligent claims services, and precise risk management through mobile payments, big data analytics, and blockchain technology. This has expanded its coverage, optimized premium structures, and demonstrated the inclusiveness and innovation of inclusive finance. However, challenges persist in promoting “Hu Huibao”, including optimizing digital claims processes, designing personalized products using big data, and balancing data sharing with privacy protection. This paper aims to comprehensively analyze the current development status of “Hu Huibao”, explore how it can continue to evolve under the influence of digital finance, and outline its future directions.