Posts Tagged ‘China Health Insurance’

China’s Health insurance Industry Trends

October 16th, 2009 youhan

       一、 China’s health insurance industry in the pioneering era
        1, health insurance competition in the market to develop. China’s current health insurance market, the supply of the main addition to China Life, Ping An Insurance, China Pacific Life Insurance, Xinhua Life Insurance, Taikang Life, Taiping Life and other Chinese-funded life insurance companies, has added a new two business entities, one new “Insurance Law” stipulates that from January 1, 2003 start, insurance companies can operate short-term health insurance business. Including the People’s Insurance Company and Huatai companies, including insurance companies early in the new “Insurance Law” introduced a few months before, they started to increase health insurance product development and professional talent pool efforts in preparation for the short term health insurance in this new market accounted for was a place. As the past five or six years, the insurance companies in premiums relative to life insurance companies, the growth has slowed down (in 2002 the national property and casualty insurance premiums accounted for about a quarter of total), whether for competition in the market the need for or the firm’s capabilities requirements, insurance companies will vigorously explore both short-term health insurance, including a new business. Second, with China’s accession to WTO, the protection insurance market, shortened, and more has an international background in life insurance joint venture will be fully penetrate China’s insurance market, health insurance is bound to exacerbate the intensity of competition in the market. Are already doing business with its joint venture life insurance company health insurance than the rich management experience and technology, a breakthrough in the traditional sense of the mindset of medical insurance, according to market demand to provide health insurance products. As in September 2002, Sun Life Everbright Life Insurance Company (Sino-Canadian joint venture) launched the “ill worry-free” insurance, the kinds of major diseases to protect patients from 25 kinds of expanded to 33 species, becoming the highest protection of diseases a disease re-insurance . There are companies who will be spidered, another important category of health insurance – disability income insurance, launched a content-rich portfolio of health insurance products. Such as the CMG Corporation (Sino-Australian joint venture) in January 2003 devaluation in China, “regular life insurance income protection” products to meet the listing over the same period “Additional long-term disability income protection insurance,” constitutes a “Golden Collar worry-free insurance Plan “and so on. 
     2. Chinese-funded health insurance, life insurance companies to actively explore the development. China Life Insurance Company in 2001, issued to the whole system of “promotion of health insurance on the development of guidance,” and proposed a “positive development, professional management, the overall promotion and Cost-effective,” the four guiding principles, and actively develop commercial health insurance business, and strive to improve the professional management level; China Pacific Life Insurance Company launched in the rural areas, “Jiangyin Mode” and launched in cities and towns “Xiamen mode”, all in the community caused a greater response; Xinhua Life Insurance Company in 2003, the beginning of the company’s annual work conference held in clear that this year will be to build an independent health care insurance companies; Taikang Life Insurance Company’s health insurance product development, risk control, market-driven in various segments of the overall management of sales staff qualified to carry out special assessment; China Ping An Life Insurance Company attaches great importance to development of health insurance products, in January 2003 has introduced four new emphasis on disease health insurance products, and have become re-disease health insurance products of domestic varieties of the more complete insurance companies. It can be said, individual life insurance companies are fully anticipate the development potential of health insurance, and strive to be more intense in the coming competition in the market to seize opportunities.
     3. Supplementary medical insurance for employees starting point for business, health business-funded life insurance companies to maintain rapid growth. Since 2001, Chinese-funded life insurance companies to use national medical reform have given a good opportunity to seize in a relatively short period of time after the workers throughout the health reform supplementary medical insurance market. In their supplementary medical insurance-related driven by strong insurance, individual life insurance companies health insurance premiums in 2000 averaged 98.94 percent year on year growth rates, life insurance premiums than the national growth rate of 39.19 percentage points higher than the same time, health insurance premiums in life insurance business, the proportion was gradually rising trend. 
      

      二、China’s commercial health insurance trends
    （一） commercial health insurance industry is facing a good opportunity for development
In recent years, as soon as possible to establish a market economy needs to adapt to new social security system, has become a broad consensus. As an important component of the social security system, commercial health insurance, and its importance more obvious each day, can be said that China’s current health insurance is facing great opportunities for development, whether from the external policy environment, or from the internal operating environment, to develop commercial health insurance, unite in the basic conditions.
     1. The external environment is very conducive to the development of health insurance. First, a comprehensive medical insurance system reform in depth for commercial insurance companies in the country to carry out commercial health insurance, urban and rural areas has provided a broad space for development. In 2000, the State Council’s “on improving the social security system for urban workers, the pilot program of work notice” has made it clear the establishment of the basic medical insurance system for urban workers, the basic principles put forward the national health security system, the basic idea of this supplementary medical insurance for urban workers leaving a huge market space. In October 2002, the National Rural Health Conference should be made to co-ordinate the establishment of major diseases mainly of new rural cooperative medical system with individual farmers make payments, the collective support and government-funded combination of funding mechanisms to support farmers in various forms of access to basic health care protection, to encourage farmers to participate in the commercial health insurance. According to preliminary estimates, urban basic medical supplementary medical insurance premium, and farmers the potential of up to 100 billion yuan, health insurance will no doubt become the life insurance companies to maintain business as an important support for high-speed growth. Second, China Insurance Regulatory Commission attaches great importance to the development of the health insurance industry. In December 2002, China Insurance Regulatory Commission issued a special “Regulations on accelerating the development of guidance for health insurance” (hereinafter referred to as “guidance”), accelerating the development of health insurance, the enhancement of health insurance, professional operation and management, establish to adapt to national conditions and health insurance, the principle of the development model, etc. requirements. China Insurance Regulatory Commission has held numerous forums, seminars implementation of the development of health insurance policies. Third, China’s health care environment is constantly improving. Since 2002, the State Department stepped up medical insurance, health care and the pharmaceutical distribution system “from three years to simultaneously proceed with the”, so that drug prices and medical service costs has been initially brought under control. According to statistics, national health care reform before the General Hospital Health System 1990-1998, the average per annual growth rate of outpatient and inpatient costs were 25% and 23%, respectively, after the reform in 2001 reduced to 9% and 5%. Not long ago, the State Council has twice emphasized that “China’s social security health insurance is an important component of the system,” to speed up the commercial health insurance pilot work for the commercial health insurance, pointed out the direction of development. Ministry of Health, Ministry of Finance and the China Insurance Regulatory Commission and other relevant administrative departments, is actively study and formulate policies to support commercial insurance companies and health care service providers to carry out in-depth cooperation in the effective control of the business operating costs. Fourth, the increasing demand for health insurance market expansion, particularly in urban group supplementary medical insurance and basic medical insurance for the farmers market demand for large, the majority of urban and affluent rural areas, the public becomes more aware of the strong insurance, health insurance, consumer psychology has become a virtuous and so on.

        2. The development of health insurance, the internal business environment is moving in the direction of the evolution of sound. First, health insurance, part of the business risks can be a degree of control. As long as they filed past, health insurance, the insurance industry is generally believed that their business risks are relatively large, the loss ratio is too high. In fact, the current life insurance companies pushing products are the main supplementary medical insurance workers, and the past, particularly in relation to traditional health insurance, “designed to promote the main risks of additional health insurance,” is entirely different. Because of its link with the social security sector to carry out supplementary health care services, business risk is relatively easy to control. The basic medical insurance as government actions, mandatory, and to better regulate the hospital’s medical care. Life insurance companies can through the information system interface, the joint office with the form of convergence, either indirectly insured medical expenses and true information, but also can simplify the claims process and reduce operational risks. From a business management perspective, the social security sector is the first line risk control “firewall”, in other words, social health insurance valid for the commercial medical insurance, the incidence of spread of the most concentrated part of the crowd and the risk of common diseases, life insurance companies can take full advantage of the social security departments of medical institutions to manage results. In addition, in recent years, Chinese-funded life insurance companies in the business model and risk management tools on a useful exploration in some areas has been made in the health insurance business success stories. Second, the existence of health insurance premium rate increase space. Through recent years, the health insurance business, life insurance companies have accumulated a large number of effective base data, more a large number of front-line operational staff to conduct market research, which is conducive to statistics, suggesting a guiding market rates. In a sense, China’s current health insurance market in its infancy, and the supply lags far behind the demand. In parts of Guangdong Province as an example, additional medical insurance average rate of hospitalization from 30%. Raised to 50 ‰, experienced only a short period of time more than a year, they are quickly digested and accepted by the market. Since the rate increase there is room for the needs of society they exist in large numbers, a significant increase in premium income also the possibility of payment rate will decline due to an increase in premium, life insurance company’s business will be more stable, the majority of the interests of insurance policyholders will be more secure. This will be a positive chain reaction. Despite the current health insurance, life insurance companies operating in one way or another, there are still difficulties, but as long as we continue to adapt to the new development situation, and strive to improve their management level, health insurance, life insurance companies will eventually become an important group of products into parts, for the stability play an important role in people’s lives.

       (二) the health insurance industry will gradually enter the orbit of specialized operation

     Health insurance, professional management, including the meaning of both, one in business development orientation, on the health insurance as one of the main business to be planning; Second, in the direction of institution-building, in accordance with operational requirements to build professional business operation system.

      1. Health insurance business model. China Insurance Regulatory Commission, “guidance” to define the professional development of China’s commercial health insurance, the direction and requirements. In the professional management issues, health insurance is way out is to take the professional management of the road. Life insurance company health insurance business model is to establish a sound management system for the insurance professional. Fully demonstrated at home and abroad business practices, professional management can fundamentally improve the level of health insurance business, effective control of operational risks, is to ensure that health insurance, long-term plan for sustainable development.

     2. Health insurance, the financial evaluation system. Given the special nature of health insurance business, China Insurance Regulatory Commission “guiding opinions” explicit requirements for health insurance with a separate assessment and professional actuarial system. Health insurance-on management, health insurance will provide the basis for a separate evaluation conditions.

       (三) the development of health insurance Thoughts

Health insurance business in the insurance industry has been called a “worldwide problem”, the development of health insurance to the Chinese-funded life insurance company’s innovative capacity and overall strength will be a comprehensive test. In the rare opportunities and severe challenges, the Chinese-funded life insurance companies, no matter how much must be to overcome the difficulties step by step to the completion of a number of pioneering work seriously. Past couple of years necessary to how to speed up the development of health insurance a top priority on the agenda, from a strategic perspective to develop health insurance, business development planning, from the development of practical business tactics to promote the program to comprehensively strengthen the health insurance business leadership.

At present, the first specialized information system construction as soon as possible to resolve the issue. Health insurance information management requirements in view of the high importance of statistical analysis. China Insurance Regulatory Commission “guiding opinions” clear requirements, health insurance, information technology necessary to implement specialization, which reflects the company’s health insurance, the management level and service advantages, promote the rapid development of main insurance business. Second, is to improve the professional management system, system construction. He Pei specialized underwriting business health insurance system is a necessary requirement risk control, nuclear security is the core of business management. China Insurance Regulatory Commission “guiding opinions” expressly requested that the professional management must be the establishment of specialized underwriting Hepei system, and should focus on human, material and financial resources as soon as possible organizations to develop a corresponding set of management system. These include: health insurance management and underwriting claims management operating procedures manual for health insurance services, operating procedures and medical services such as supervision and management methods. The third is to strengthen professional sales management system. According to the operating characteristics of health insurance, professional selling is an important means for marketing, but also an effective risk control measures. In the professional sales force has not been established before the health insurance professional sales department may rely on rules and regulations and management practices, implementation of sales risk control, operations can be with the company’s existing sales channels. At present, group health insurance supplementary medical insurance is the focus of expansion, and enterprises, the cooperation between the Government and the insured amount is mainly a large group alone business, in order to direct the main risk group, while broadening distribution channels can make full use of intermediaries services and insurance brokerage business. Fourth, strengthen international exchanges and cooperation. By absorbing foreign advanced management concepts, improve their management level, to explore with Chinese characteristics and the formation of a new health insurance business model. Such as: to explore with the health sector to provide quality medical services and medical technology support, control health care expenditure patterns of cooperation and so on.

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China Health Insurance And Health Management Integrated Model Of Discussion

October 16th, 2009 youhan
        Since 2004, China’s insurance industry set up the first specialized health insurance companies has been on health insurance and health management to explore how to combine the theory and practice in an increasingly in-depth exploration, but now, from the internal and external evaluation of the industry point of view, The combination of these two hard to satisfactory results. Hope to trigger some discussion of the text in order to be the promotion of the cause of this.
 
Review and Present Situation Health management ideas and practices first appeared in the United States, it refers to the health of individuals or groups to conduct a comprehensive monitoring, analysis, assessment, providing health advice and guidance, as well as risk factors for health of the whole process of intervention, which aims through the efficient resource utilization to achieve the greatest health outcomes. The theory of meaning health management in broad terms the specific forms of realization are therefore much variety, from the physical examination, health assessment, sports and fitness, to lifestyle management, chronic disease management, and even traditional Chinese medicine health and much more . The reason for the health insurance and health management with a combination of reasons, there is a more unified understanding of the industry can be achieved through health management to improve the health status of the insured population, thereby reducing their medical expenses and reduce the rate of health insurance payment.

Abroad, the theory and practice of professional experience in health insurance, when introduced into China, there are many concepts (such as managed care, HMO, etc.) that contains the contents of its broader, which filled our understanding of health insurance and health management has been a combination of modes deviation, and even think that health care network management are also part of health management. In fact, the foreign professional health insurance companies in the medical expenses of the control, is two-pronged approach: the first medical provider network or health care management (eg, treatment services and medication review, specific treatment services, pre-authorization system, medical institutions, performance appraisal, etc.), audit unreasonable expenses, through benefit-sharing mechanisms to manage the health care provider behavior; second is the adoption of the above mentioned health management to improve the health status of insured groups, thereby reducing the medical expenses. The so-called health insurance and health management combination, refers to the latter. Of course, with the cooperation of health care providers, you can introduce a certain incentives to demand its insured to provide health management services (such as vaccination, health counseling, etc.). This is evident from expressions of view, is a medical network management and health management into one, but logically, the right health care network management and introduction of health management services to health insurance companies try to control medical costs of two kinds of means, each with of different expertise. From China’s current situation of health insurance companies and medical institutions (in particular, there is a strength, has been widely trusted by people in large medical institutions) of the game process, still vulnerable position, hard to form a community of interests, health insurance companies hoping to Build your own managed health care network is difficult and still very great. In addition, mainstream medical institutions are still concerns treatment of disease, the short-term fear is also too busy to help the company to provide further health management services. Thus, the domestic health insurance companies are mainly through independent third-party health management companies, to outsource services-based, self-built service, supplemented by way of providing health management services to clients. Services have a health consultation, health check, health assessment, appointment register and lifestyle management. However, on the one hand because the domestic health management services industry is still in its infancy, effective health management services, supply capacity is not enough; the other hand, the health insurance industry is still in its infancy, how to integrate health management services to the insurance risk control process has not yet matured into the model. Therefore, health insurance and health management of the combined form still rudimentary, health management services, primarily for the exhibition industry, the marketing tool of risk control for the role of medical expenses is not yet obvious, and difficult to account for health benefits management services.

Principles Health insurance companies in recent years on how to integrate the field of health management services, has done a lot of exploration and practice, many of whom are successful experiences, but also into the off errors in the development review process, it seems a few basic principles can be summarized, as health insurance companies the choice to carry out health management services guidelines. (A) based on the principle of insurance, the main industry. Health management technology and services to a variety of ways, but as a health insurance company in the selection of external services, integration of resources, or build their own service project, the insurance must be based on the primary industry itself, that is carried out by health management services must contribute to the development insurance business, controlling expenses paid and avoid vague position, in order to make health management and health management to do, so that the health management and health insurance, made of two separate business areas, there is no point of integration has become a "Liangzhang Pi." (B) the costs and benefits of matching principle. The field of professional health insurance companies is limited because of operational and business risk management and control is difficult, and generally in the "survival" of the early days, the financial pressure significantly. In the cost of extremely tense situation, carrying out health management services to more costs and benefits should adhere to the principle of matching. Some health management services appears to be simple, but if large-scale implementation, the actual cost of the necessary human and material resources are not small. In order to build customer health record, for example, due to various hospitals, medical institutions of medical reporting formats vary, it is difficult to achieve a direct exchange of data that, if carried out in all insurance customers this service, only the medical reports and review input links artificial workload is high, but the services can bring benefits (for example, to enhance customer satisfaction, lower paid, etc.) is difficult and cost-match. (C) service differentiation principle. Health Management Services supply and the supply of any product, should be aimed at different target customer base while differentiation. Health insurance companies to provide health management services, have to combine the characteristics of insurance business further subdivided. For example, chronic disease management is to maintain health and control health care expenses in an effective way, but for insurance companies is precisely the population suffering from chronic diseases is a high-risk customers. In underwriting a risk the autonomy of the higher channels, should be part of the underwriting risk to be screened (eg, fees, exemptions or exclusions, etc.), rather than underwriting and then passively through the implementation of chronic disease management to risk control. However, in the field of social security supplementary services, insurance groups can not be selected at this time according to past payment history of chronic disease groups chosen to carry out targeted chronic disease management, you can play a lower paid role.

Model proposed According to these principles, combined with the current health insurance, internal and external environment, or from several fields to promote health insurance and health management model of a combination of practice: (A) the social security supplementary services for customers in specific diseases of chronic disease management services. As noted above, such operations can not be selected underwriting group, so through effective health education, health tips, behavioral interventions, such as a set of chronic disease management services, on the one hand can help to control medical expenses, and to show the professional health insurance companies, risk control capability, on the other, can improve patient satisfaction, and thus promote the social security sector partnerships will be of such business relationships based maintenance mode gradually evolved as a professional health management technology-based maintenance model, further enhance the stability of such operations to achieve the patient’s health was improving, the social security sector must enhance the reputation, business insurance profits may have to raise the win-win situation. In addition, because the cost of carrying out the service and availability of the direct benefits (ie, the amount paid reduced rate) are measurable, so we can clearly calculate the input-output ratio of this service. (B) For a small minority of customers throughout health records management services. The health of the file mentioned here is not simply input the medical report, but around the customer life cycle, through his physical examination, Chuxian claims, health consultation, the health of the whole process of information gathering, and thus the formation of health records, and thus produce targeted Report of health assessment and health recommendations for improvement. Clients can be purchased to ensure renewal of the high medical expenses-type, high pay period of heavy disease type, or a high period of the investment products paid customers. The company may take an annual medical examination services, presented the way, year after year to collect information on the health status of clients, and through health assessment and health promotion programs and other value-added services to increase customer satisfaction, thereby enhancing customer stickiness. In the meantime, the former two types of customers, the company has real-time control over their health status changes in the trend of enhanced ability to control the risk of payment. In addition, countries are promoting the building of universal health records work, ahead of companies such operations carried out for the relevant government departments can also provide good advice and suggestions. (C) for the public health consulting services. Channels such as through the company’s Web site to the public transmitted diseases, medication, health management, and treatment recommendation of such knowledge and information, both play a role in education, consulting, but also can improve the company’s professional brand image. Health management services for more than three, respectively, from the medical cost control, customer experience improvement, upgrading the company’s brand with the three health insurance to do the binding, and without the need to mobilize a lot of medical resources, from the current industry, internal and external environment is concerned, should be more feasible to attempt the direction.

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