How will the new version of the health insurance management measures land insurance enterprises in three variables?

"With the basic establishment of the universal health insurance system, continuous improvement of medical technology and services, great changes have taken place in the structure of health insurance products, the connotation of services, and the population to be guaranteed, which pose many new problems and challenges to the construction of the health insurance system and market supervision." The head of relevant departments of the CIRC responded to the public's concerns Recently, the health insurance management measures (2019) (hereinafter referred to as the measures), which took two years to revise, was finally released and will be officially implemented on December 1 The measures comprehensively revised the definition and classification of health insurance, product supervision, sales operation, etc., while the implementation of the previous version of the revised regulations still dates back to 2006 What changes have taken place in the health insurance market in more than ten years? According to the data of China Insurance Regulatory Commission, in the first three quarters of 2019, China's health insurance premium income was 567.7 billion yuan, an increase of 31% year-on-year, accounting for 22% of the life insurance market - only 12% in 2015 From the perspective of function and function, health insurance has become an important part of the national multi-level medical security system And the increasingly mature regulatory environment is bound to give birth to more healthy development opportunities How can insurance companies grasp them? As one of the highlights of this revision, the measures include medical accident insurance into the scope of health insurance on the basis of medical insurance, disease insurance, disability income loss insurance, nursing insurance, etc According to the person in charge of bancassurance, due to individual differences, disease complexity and limitations of medical technology, the same medical behavior may have different medical results for different patients; it is precisely based on the incomplete correspondence between "behavior" and "purpose", that "medical accident" has its legitimacy and opens a market segment for medical accident insurance Does this mean a new type of insurance blue ocean? "From the perspective of the whole insurance market, the entry of medical accident insurance into the measures has not had much impact." "Medical accident insurance has existed before After the revision of the measures, the cake of the insurance market has not become bigger, and the competition has become more fierce," said Wu Jun, CEO of cepstrum insurance Chen Xiuguo, partner and chief product officer of health insurance, said: "originally (medical accident insurance) belongs to accident insurance, but now it is artificially classified into health insurance To take a step back, this time, we just added a name, lacking the corresponding rules and regulations, so it will not have any impact in essence " According to the original design of medical accident insurance, it can avoid the problem of liability attribution to a certain extent For medical accidents, the part attributable to medical staff is "paid" by the hospital, on the contrary, it is the patients themselves However, medical problems will inevitably encounter the situation that is not easy to distinguish or impute responsibility At this time, medical accident insurance can play a corresponding role in the protection "After all, the market competition of medical accident insurance still falls on talents." Wu added that how to gather a group of professional teams in medical accidents will be the key to the success of "brave men in narrow ways" According to the provisions of the original measures, only short-term health insurance products can be adjusted, while long-term health insurance (usually with an insurance period of more than one year) faces the dilemma of lack of policy support for rate adjustment and slow market development "On the other hand, it can be understood that due to the hot market of short-term health insurance, in order to control the risk of long-term products, the measures specially added a similar channel to the latter this time." Chen Xiuguo explained There is no doubt that the adjustment of long-term insurance rate is win-win From the point of view of the insurer, the reason why the insurance companies seldom develop long-term insurance before is that most of the risks come from the medical inflation and medical technology progress which are faced by the fixed rate, resulting in the increase of expenses; from the aspect of the policyholders, the worry about the insurance companies stopping selling insurance products at will (in response to the risk of rising expenses) also restricts the innovation and development of long-term insurance Yang Zheng, chairman of the health insurance committee of China Insurance Association and chairman and CEO of Ping An health insurance, once pointed out that the rate of long-term insurance can be adjusted, so that the form of renewal insurance products can be integrated with international health insurance, providing system guarantee for insurance companies operating long-term health insurance, promoting the diversified development of health insurance products, and providing consumers with flexible long-term medical care Health care "The rate of long-term insurance can be adjusted, which is a precedent in automobile insurance," Wu added "It is a driving behavior based insurance (UBI) For example, if the driver keeps a good driving record, the less violations or accidents occur, the insurance company can reduce the premium according to these performances In essence, the adjustable rate of long-term insurance aims to guide users to develop positive habits In terms of health, it is to promote self-health management of users, so as to achieve a win-win situation between insurance enterprises and consumers " But at the same time, insurance companies also need to think about the subtle relationship between market size and profit Wu Jun believes that the larger the scale of the insurance market, the lower the insurance companies' compensation costs and the more lucrative the profits will be However, with the improvement of users' health management level, individual insurance costs will keep falling "When it comes to the insurance market as a whole, the smaller the plate is, one of the hidden worries of insurance companies is that it will become smaller and smaller Under this logic, if we pursue scale, the profits that insurance companies can use to continue to expand the market will be further reduced; when insurance companies lack sufficient profits to maintain normal operation, we must rely on increasing premiums to survive, and the original open market will shrink " Wu Jun's analysis said that the adjustable long-term insurance rate, on the one hand, is conducive to the innovation of insurance types, on the other hand, insurance companies also need to find a balance point of risk control From Article 10 "the insurance company shall strengthen the cooperation with medical service institutions and health management service institutions" to Chapter 6 "health management services and cooperation", health management can be said to have completed the transformation from behind the scenes to in front of the stage According to the measures, insurance companies can combine health insurance products with health management services to provide health risk assessment and intervention, disease prevention, health examination, health consultation, health maintenance, chronic disease management, health care and other services "Adopting the form of health management and reducing the loss ratio of insurance will undoubtedly have great attraction for cross industry cooperation." Chen Xiuguo said that the content of health management appeared as a special chapter for the first time in the measures, which will be a new direction and trend worthy of attention In terms of data, the measures increased the proportion of health management expenses in pricing from 10% in expenditure category and 2% in consultation category to 20% In addition, for services exceeding the 20% limit, they can also be priced separately, and the price of health management service can be indicated in the contract.