Zheng Gongcheng: Health insurance should not only prevent becoming "free medical care", but also "leave room" for commercial insurance

Illness is an inevitable risk in life, health is the most universal demand for people's livelihood, medical security is the basic system guarantee to deal with the risk of life disease and promote people's health quality.
against the background of the country entering a new era of building a modern and powerful country in an all-round way and the construction of a healthy China as an important development goal, it has become a very important and urgent task to speed up the construction of a multi-level medical security system with Chinese characteristics.
china established a medical security system consisting of public-funded medical care, labor insurance and rural cooperative medical care in the 1950s, and achieved the goal of reaching the whole population.
The system is based on the traditional socialist public ownership and is integrated into the country's highly centralized planning system, which has made great contributions to relieving the worries of the people in the face of disease, improving the health quality of the whole people and realizing the continuous extension of life expectancy, but there are also shortcomings such as urban-rural division, closed operation, single level of responsibility and protection.
After the reform and opening up, with the transformation of the economic system from planned economy to market economy and profound changes in social structure, the organizational and financial basis supporting the original medical security system has also been shaken, and the reform of the original medical security system has become one of the core contents of the reform of China's social security system.
After nearly 20 years of exploration, the original three systems have been replaced by the socialized basic medical insurance for urban and rural workers, medical insurance for urban and rural residents (both of which constitute basic medical insurance) and medical assistance system, and the gradual development of commercial health insurance has formed a framework of the medical security system of urban and rural integration, responsibility sharing, socialization and operation, and multi-level structure.
, especially since the comprehensive promotion of the reform of the medical and health care system and medical insurance in 2009, China's basic medical insurance has covered more than 95% of the country's population, and the goal of universal health insurance has been initially achieved.
2016, the Central Committee of the Communist Party of China and the State Council issued the Outline of the "Healthy China 2030" Plan, which sets out the goal of improving the multi-level medical security system supplemented by basic medical security and other forms of supplementary insurance and commercial health insurance.
In February 2020, 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, a programmatic document on the construction of a medical security system with Chinese characteristics, which further clarifies that the construction goal of the system is to fully complete the medical security system with basic medical insurance as the main body and medical assistance as the base, supplementing medical insurance, commercial health insurance, charitable donations and mutual development of medical assistance.
these two important policy documents meet the development requirements of the new era and the people's demand for multi-level and diversified medical security, and provide clear guidance for the construction of a multi-level medical security system with Chinese characteristics.
However, while basic medical insurance is moving towards universal access, the development of commercial health insurance is lagging behind, and the construction of multi-level medical security system is still in a state of disability, which makes the people's multi-level and diversified medical security needs unable to be effectively met, and also makes the material basis of the whole medical security system unable to continue to grow because it can not fully mobilize the enthusiasm of market subjects such as commercial insurance companies and the increasingly abundant resources of the people, thus restricting the sustained and healthy development of the medical security system and the continuous improvement of people's health and well-being.
Therefore, under the condition that the universal medical insurance system is about to enter a period of stereotyped, stable and sustainable development, how to develop commercial health insurance is not only a problem worthy of serious consideration by China's commercial health insurance industry, but also a major issue that the country needs to face up to in order to promote the sustainable development of the whole medical insurance system.
China's commercial health insurance is with the beginning of the 1980s to resume domestic insurance business, in the past 10 years in the product structure, service connotation, to protect the population and so on have undergone great changes.
but compared with the more mature insurance market, commercial health insurance as an emerging market has not been truly effective development.
From the reality, the current level of commercial health insurance specialization is not high, especially the early alienation has become a kind of financial products;
In fact, basic medical insurance and commercial health insurance are the basic tools and management means for human beings to deal with disease risk and promote health, especially the new crown epidemic has brought human beings to deal with the social uncertainty of modern post-industrial risks, the two can not replace each other, should be under the premise of clear division of labor to achieve coordinated development, win-win cooperation.
At the same time, the reason why the construction of multi-level medical security system as an important goal of reform is to make full use of the market mechanism and social mechanism, to maximize the mobilization of various resources, strengthen the material basis of national welfare, while making social security responsibilities in the main parties to get a more reasonable allocation, and ensure the sustainable development of the whole system.
most important aspect of promoting commercial health insurance is to define the boundaries of social health insurance and the policy environment that encourages the professional development of commercial health insurance.
, we should adhere to the basic medical insurance "guarantee the basic, promote fairness" attribute, maintain the limited responsibility of the government, not only to prevent universal health insurance into free medical care for all, but also to make room for the development of commercial health insurance.
In operation, it can be promoted to take the reimbursement level within the scope of the basic medical insurance policy as a measure to change to the actual compensation level of medical expenses to avoid disease leading to poverty, serious diseases lead to catastrophic life consequences as an evaluation index, the low level of basic medical insurance coverage is not enough to solve the people's worries about disease High can not guarantee the sustainable development of the system, and let the individual properly bear a certain amount of medical expenses is necessary and reasonable to pay as the first person responsible for their own health, but also fully reflect the fairness of the basic medical insurance system, so as to promote high-income groups through the market to seek a higher level of health protection.
, on the other hand, fiscal and tax policies, preferential tax rates, etc. are needed that are conducive to the development of commercial health insurance.
These contents are reflected in the Outline of the "Healthy China 2030" outline issued by the CPC Central Committee and the State Council and the Opinions on Deepening the Reform of the Health Care System.
, the development space of China's commercial health insurance is mainly high-income people and basic medical insurance reimbursement outside the scope of the self-funded costs.
The assumption is that if 5% of high-income earners become real customers of commercial health insurance, the total will exceed the total population of France, and if it reaches 10%, it will surpass the total population of Japan, which is undoubtedly the world's largest commercial health insurance market."
China is about to enter the ranks of high-income countries, the middle class group size is growing rapidly, the potential large number of insurance customers decided that China's commercial health insurance will be a commercial insurance companies and other market entities to open up a huge market.
In the face of such a broad market prospects, in addition to constantly optimizing the policy environment, the key is that market subjects should have a strategic vision and adhere to the premise of insurance principles to cultivate the health insurance market, and in line with public demand to develop marketable, professional health insurance products, cross-industry cooperation is undoubtedly the only way.
multi-industry cooperation will help accelerate the development of commercial health insurance.
Currently, regulators and the commercial health insurance industry are working to promote the professional operation of commercial health insurance, which requires commercial health insurance companies to form core competency in areas such as disease knowledge maps, real-world data, health care networks, and health management systems, and the pharmaceutical industry has a strong foundation in this regard.
years, the pharmaceutical industry and commercial health insurance companies in the field of cancer targeted therapy promotion, special drug efficacy insurance and chronic diseases have carried out related explorations, and achieved positive results.
if the situation of multi-party cooperation can be fully opened up, then health insurance, medicine, medical "three doctors" can form a benign interaction, coordinated development pattern, and ultimately benefit all the people.
In short, under the guidance of the Health China Strategy and the Opinions on Deepening the Reform of the Health Care System, in a modern post-industrial risk society full of uncertain events, as an indispensable level of multi-level medical security system and an important complementary force of basic medical insurance, the positioning of commercial health insurance will be more accurate, the objectives will be more clear, and the direction of efforts will be more correct.
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