The full coverage of major disease insurance is difficult to hide the five major problems the CIRC issued five consecutive articles to fill the loopholes

The rapid development of major disease insurance is difficult to hide the existence of unclear positioning in the course of operation, low overall level, small medical control, protection policy is not unified, the ability to run insurance enterprises is insufficient five major problems. Yesterday, the CIRC issued five documents in a series, in bid management, service standards, financial accounting, risk adjustment, market exit five aspects of the rules to close the loophole.Fast disease medical insurance development is rapidly five-text to fill loopholes
Yesterday, the CIRC issued a series of "insurers urban and rural residents of major diseases insurance tender management interim measures," insurance companies urban and rural residents of major diseases insurance services basic norms (trial), insurance companies urban and rural residents of major diseases insurance financial management interim measures, insurance companies urban and rural residents of major diseases insurance risk management interim measures and "insurance companies urban and rural residents of major diseases insurance market exit management interim measures."
Zhu Junsheng, a researcher at the Institute of Finance of the Development Research Center of the State Council, believes that in order to prevent vicious competition from killing each other, the bid management documents make it clear that more than two insurance companies can form a bidding union to bid as a bidder. For the low level of co-ordination and other issues, in the State Council Information Office held a press conference, CIRC Vice Chairman Huang Hong suggested that, first of all, the development of major disease insurance should adhere to the basis of urban co-ordination, in principle, can not engage in county-level co-ordination, and gradually support provinces and cities to implement provincial co-ordination, and then transition to national co-ordination. Zhu Mingli, a professor in the Department of Insurance at Nan kai University, said that for the co-ordination of the issue of social relations, local finance and other departments, among them, the insurance premiums for major diseases is the allocation of funds for the medical insurance fund, how to connect to the current is the hierarchical management of the health insurance fund has yet to be considered.The overall level of low-start capping line high
" China's major disease insurance covers 1.05 billion people, of which, the average per capita reimbursement of 7138 yuan, the highest reached 1.116 million yuan. Huang Hong revealed. The so-called "big illness insurance", that is, urban and rural residents of major illness insurance, is the government from the medical insurance fund to allocate funds to buy major illness insurance from commercial insurance institutions, the insured suffering from high medical expenses, after the basic medical insurance reimbursement needs to personally bear the compliant medical expenses, to give "secondary reimbursement." Although the operation of major illness insurance in the process has made remarkable achievements, to a certain extent to resolve the previous difficult to see a doctor, expensive to see a doctor and return to poverty due to illness and other issues, but the problem remains to be solved.
One analyst pointed out that for commercial insurance companies themselves, insufficient capacity-building has become the biggest internal cause
; Nearly half of the 605 major disease insurance programs do not have a cap line. This is not actually in line with the law of the operation of major disease insurance, while the problem of over-medical treatment and over-examination still exists.Qualified three-year operation of the first exit mechanism
At present, most of the insurance companies operating major illness insurance in a loss-making state, in order to prevent insurance companies from withdrawing, and prevent a large number of medical, insurance and other data involved in secret, the CIRC also in the insurance company before and after the operation of major disease insurance set up two levels, that is, to limit three years of operation and introduce exit mechanism.
insurance company's winning bid in the bidding management measures, it shall sign a cooperation agreement with the policyholder on insurance against serious illness in accordance with the provisions of the tender documents. The term of cooperation agreement on major disease insurance shall not be less than three years in principle, and the contents of the insurance contract for major diseases may be negotiated and determined once a year. Zhu Junsheng said that insurance companies to undertake major disease insurance business needs and insurance supervision, medical insurance and other departments docking, and also need to configure professional medical personnel. Exiting if a year's loss is severe is not conducive to cross-year risk diversification.
Huang Hong also said that every year, the insurance for major diseases will be included in the special inspection, the violation of laws and regulations strictly re-investigated, the weak service capacity of institutions to put forward rectification requirements. Take measures such as disqualified and severely punishing the responsible personnel for malicious bidding found in the on-site inspection, and seriously deal with the improper benefits of falsely obtaining expenses and taking advantage of the insurance business of major diseases. (China Insurance Regulatory Commission Beijing Business Daily)