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.