Under the blueprint of deepening health care reform, how to develop commercial insurance

On February 25, 2020, the CPC Central Committee and the State Council officially issued the Opinions on Deepening the Reform of the Medical Security System (hereinafter referred to as the Opinions), which is the framework document for China's medical security to enter a high-quality stage of development.
Opinions plan the blueprint for the reform of the health insurance system in the next 10 years, and put forward new requirements for commercial health insurance in the areas of building multi-level security, perfecting product supply-side reform, strengthening supervision, and participating in the management of medical insurance.
with the acceleration of the aging society and urbanization process, the people's living standards continue to improve and the demand for health care is released, the commercial health insurance sector has a very large market potential.
same time, as people become more aware of health, public health and insurance protection, the market has put forward higher requirements for risk management and product development capabilities in the insurance industry.
the overall development strategy of commercial health insurance in the new period, the four core work should be clarified.
(1) Target market: Commercial health insurance should be differentiated from basic health insurance, positioning the target market to provide higher-level, more diversified coverage and services (e.g. high-end medicines, health care, etc.) for those with higher demand for medical services.
(2) Profit model: the future development of commercial health insurance is not only the development and sale of insurance products, but also the construction of health services chain and benefit-sharing chain composed of medical services, drug supply, health management and other industries (such as intelligent audit system, drug welfare management, etc.).
(3) Strategic Investment: Actively explore the establishment of their own medical and pharmaceutical services system.
commercial health insurance specialization should be a highly integrated system of medical and insurance.
(4) technology empowerment: to establish customers' health big data, to solve homogenized competition, poor customer viscosity, information asymmetry and other issues, while at the same time to achieve the goal of effective risk control.
the overall development strategy of commercial health insurance in the new period, insurance enterprises should focus on four aspects in further enriching product supply and improving service capacity.
first, and actively develop inseconseurance insurance.
the objective existence of diseases, natural disasters and accidents, the need for income compensation for permanent and short-term disabilities has also persisted.
But in the current medical security system, whether it is basic medical insurance or all kinds of complementary commercial health insurance, the focus is on the protection of medical expenses, most members of society lack the risk of disability income compensation.
insurance industry can use this as a potential growth point for commercial health insurance.
, actively develop expense reimbursement insurance business.
The insurance industry has been rescessing businesses such as medical expense reimbursement health insurance because the insurance industry and the pharmaceutical services sector have not yet established a mechanism for stable and mutual trust, and because there are indeed irregularities in the industry.
but in the long run, this is an important area that the commercial health insurance industry must develop.
, the insurance industry needs to strengthen research, prepare in advance, and actively create conditions for steady progress.
, one is to effectively grasp the protection needs of members of society, that is, on the basis of basic medical insurance and medical assistance to seek the protection needs of potential customers, so as to design appropriate insurance products.
is to establish a close cooperation mechanism with medical insurance departments and medical institutions, fully grasp the medical expenses data, establish a professional cost accounting mechanism, reasonable control.
, actively explore long-term care insurance.
with the aging and aging of the population, in recent years, some areas have carried out the exploration and pilot of social long-term insurance, and made some progress, but there are still many problems.
the present situation, the conditions for the recent introduction of long-term insurance in various parts of the country by means of social insurance are not yet ripe.
there is both the constraint of economic strength and the constraint of insufficient supply of nursing services.
On the one hand, commercial health insurance should actively participate in the management services of long-term insurance in the pilot areas, on the other hand, we can also explore the use of fixed payment methods, design multi-year savings-type care insurance products, commercial insurance for the middle and high-income groups of sales, while establishing an integrated mode of medical care insurance and services management.
fourth, driving industrial innovation in the industry.
Give full play to the advantages of the financing model of commercial health insurance in health management, make use of technology applications and big data, form a community of interests with health insurance, health care, pharmaceutical companies and medical equipment, provide health services through cooperation, innovative network design, transparent charging standards, achieve vertical integration with suppliers, serve the upstream and downstream industrial chain of the large health ecosystem, and promote the evolution of commercial health insurance to large health integrated service providers.
(ZGYB2020-12)