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    Home > Medical News > Medical World News > How does commercial insurance play a role in the multi-level health insurance system? These two dimensions are important.

    How does commercial insurance play a role in the multi-level health insurance system? These two dimensions are important.

    • Last Update: 2020-10-06
    • Source: Internet
    • Author: User
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    On March 5, the Central Committee of the Communist Party of China and the State Council issued the Opinions on Deepening the Reform of the Medical Security System (the Opinions).
    Opinion clearly defines the principles and main tasks of the reform and development of health care reform in the new era, and will serve as a guide for the reform and development of health care reform for a long time to come.
    In this context, under the leadership of the Organization of the State Health Insurance Administration, China Medical Insurance magazine held a series of symposiums on deepening the reform of the medical security system, aiming to conduct in-depth discussions on topics of higher social concern, wider impact, controversial points and point-of-view orientation put forward in the Opinions, and actively guide public opinion towards development, leading the way for the smooth development of related reform work. The first seminar of
    with the theme of "sound medical insurance and relief system for serious and serious diseases" was discussed in depth by the experts who discussed the problems of establishing and perfecting the insurance and medical assistance system for major diseases and constructing a comprehensive security pattern.
    2020, the CPC Central Committee and the State Council issued the Opinions on Deepening the Reform of the Medical Security System (hereinafter referred to as the Opinions).
    paper mainly combs the paper on the role of commercial health insurance in the multi-level medical security system and the prospect of deepening the cooperation between basic medical insurance and commercial health insurance.
    mainly analyzes the current functional status of commercial insurance companies in the management of medical security, analyzes and discusses the current situation and existing problems in the development of commercial insurance, and makes clear that the main direction of the next step is to encourage development, standardize development, play a good role in the multi-level medical security system, and put forward some exploratory suggestions on the basis of looking to the future.
    Encourage development and standardize the development of whether it is to undertake as a supplement and extension of basic medical insurance for urban and rural residents of major disease insurance, or self-developed various types of commercial health insurance, from the actual sharing effect of medical costs, commercial insurance companies in the supplementary medical insurance there is still a greater room for improvement.
    According to statistics, the proportion of hospital expenses reimbursement within the scope of workers' medical insurance and residents' medical insurance policies reached about 80% and 70%, respectively, and the demand of the sick and some people with higher income levels to seek higher levels of protection outside of basic medical insurance continued to be released, and the commercial health insurance market had more room.
    experts believe that the current commercial health insurance in the entire multi-level health care system plays a weaker role.
    But in fact, the commercial insurance company has a strong development needs, you can choose some diseases, part of the population health protection claims, do a good job of commercial insurance and social security coverage convergence, the commercial insurance product structure reconstruction, to achieve a key breakthrough.
    also have experts talk about, now whether it is residents' health insurance or workers' health insurance, bearing a higher expectation of protection.
    And from the level of economic development and basic medical insurance financing status quo, not all costs can be guaranteed in place, more or through multi-level protection to solve the differentiation of needs, basic medical insurance always adhere to the basic standards of protection, can not be a big package.
    the strong participation of commercial insurance, can drive the vast number of insured people to establish a sense of participation.
    There are some experts with a positive and prudent attitude, comprehensive consideration of the past commercial insurance companies to undertake the situation of major disease insurance, think that in encouraging development at the same time should pay attention to follow-up assessment and performance evaluation, urge to improve service efficiency, improve the effectiveness of the protection of major diseases.
    At this stage, the actual service capacity of the commercial insurance company and the market to the commercial insurance company to play a major role in the overall supplementary protection expectations, there are certain differences, it is recommended to increase the cost, services, fund balances, such as assessment and evaluation, and pay attention to coordination with the CIRC, especially statistical caliber.
    horizontal expansion catalog, vertical adjustment product line experts also further explore the commercial insurance company to expand the entry point of protection.
    From the actual reimbursement ratio of various places, comprehensive consideration of the actual needs of insured persons, the level of serious disease protection there is still a greater room for improvement, on the one hand, mainly to try to increase the proportion of reimbursement in the catalogue, in the basic medical insurance, major disease insurance, and then add up a heavy protection, on the other hand, mainly to break through the basic medical insurance three directories, the comprehensive protection of costs outside the scope of policy.
    1. Exploring the out-of-catalog security space a number of participants put forward proposals to encourage commercial insurance to break through the scope of basic medical insurance catalog protection and develop corresponding products.
    , on the one hand, the use of new technologies and drugs is an irreversible trend, but because of their high prices and limited capacity to share the costs of basic health insurance, some of the costs not covered by basic health insurance have put a burden on patients.
    On the other hand, in addition to inpatient medical expenses, special outpatient clinics, outpatient surgery, inpatient front and back door emergency costs, long-term nursing costs, bed costs, etc., may also become the existing triple security system difficult to cover the corner.
    suggested that the company's targeted design of profit-keeping, price concessions of products, strengthen the system of convergence, and the masses to establish trust relations, open up the market situation, play a good role in the health risk management of commercial insurance products.
    2. The vertical adjustment product line meeting discussed that there was still some room for improvement in the sharing of individual burdens within the policy framework.
    Taking urban and rural residents' major illness insurance as an example, according to monitoring, the per capita medical expenses of residents who currently enter the payment section of major disease insurance are about 50,000 yuan, and due to the limitations of payment tools such as the starting line, co-payment ratio and cap line, further attention needs to be paid to the high-cost patients who exceed the cap line and the risk of low- and middle-income patients paying below the starting line.
    from the multi-level system function positioning, the complementary protection of commercial health insurance has great opportunities.
    the development of commercial health supplementary insurance, we must first solve the problem of "quantity". More than
    experts said that the purchase of medical insurance can also keep pace with the times, drawing on the experience of drug "volume procurement", "group purchase" of commercial health insurance for major diseases, may be better able to solve the problem and improve efficiency.
    to promote the decline of premiums by increasing the coverage of commercial health supplementary insurance, the health insurance sector and all sectors of society need to work together to strengthen policy publicity, guide the insured to take the initiative to insure, to solve the "quantity" problem.
    also concerned about the rapid development of universal commercial health insurance in some places in recent years, such as health insurance.
    Such products are relatively inexpensive, age-free, less restrictive provisions for sickness insurance, the amount of protection costs and commercial health insurance "millions of medical" products similar, the scope of protection in the basic medical insurance and major disease insurance on the basis of extension, some products cover limited diseases of anti-cancer drugs, has a certain market attraction.
    in product promotion, to varying degrees to adopt the model of social security and commercial insurance cooperation, commercial insurance companies to achieve the transition from participants to partners, to deepen basic medical insurance and commercial health insurance cooperation to make a useful exploration.
    , but in terms of local operations, there are two key issues that need to be addressed in the development of such health insurance.
    First, because the market is generally actuarial can not effectively estimate the participation rate, reverse selection of serious problems, the overall age structure of the insured personnel, physical condition there is greater uncertainty, resulting in cost measurement accuracy is difficult to ensure, the need for medical insurance department assistance, from the perspective of data information sharing to guide the company to scientifically calculate costs, do a good job of pricing guidance, while co-promoting publicity work, improve coverage, to achieve medical security with volume procurement, volume exchange.
    Second, part of the universal insurance covers a certain number of drugs, commercial insurance companies in the failure to establish a strong wind control system, involving limited coverage of special drugs, it is recommended that the health insurance sector can be based on the actual situation, from the high incidence, heavy burden of disease, in the dynamic adjustment of the basic medical insurance catalogue, more precise focus on the high cost of serious diseases protection, to more insured people to bring greater benefits.
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