Deepening the Medical Reform Government Market "Using Both Hands"

The executive meeting of the State Council on August 27 decided to speed up the development of commercial health insurance, help medical reform, and improve the level of medical insurance for the people. The meeting held that deepening medical reform requires the government and the market to use both hands. The use of reforms to mobilize social forces, develop commercial health insurance, and form a joint force with basic health insurance will help improve people's medical security and meet multiple levels of health needs.

Insurance companies run medical insurance, the cost is less than the government's own investment

The meeting proposed to comprehensively promote commercial insurance institutions entrusted with contracting urban and rural residents with serious illness insurance, draw a certain proportion or amount of insurance funds from the urban residents' medical insurance fund and the new rural cooperative fund, establish a system of serious illness insurance for urban and rural residents, and increase the proportion of medical reimbursement for serious patients. . Encourage medical institutions to become designated medical institutions for commercial insurance and reduce unreasonable medical expenses. At the same time, it explicitly proposed to increase government procurement services, introduce competition mechanisms, and support commercial insurance agencies to participate in various types of medical insurance management services.

“Insurance companies have more professional advantages in actuarial accounting and cost control, and many companies can diversify risk and increase the efficiency of fund use at the head office level,” said Song Fuxing, an industry expert and Party committee secretary and president of the People's Health Insurance Company of China. From the Medicare Fund and the New Rural Cooperative Fund, it is possible to significantly increase the coverage of serious illness insurance for residents; the insurance service will be transferred to the insurance company. Insurance companies will only increase the marginal cost, and the handling cost will be less than the government. Self-employment; insurance companies intervene in the control of medical expenses, can effectively curb the practice of hanging bed hospitals, virtual medical expenses and other practices, to prevent the health insurance funds run counterfeit.

At present, there are 11 insurance companies in China that carry out major illness insurance business in 144 areas in 25 provinces, covering 360 million urban and rural residents. “The insurance industry must establish three types of service: basic medical insurance, major illness insurance, and basic medical insurance major disease insurance, strengthen the service orientation of the medical insurance management and medical service paying parties. With professional services, actively cooperate with the government to solve the medical reform. This is a worldwide problem," Song Fuxing said.

We must have a "big insurance" concept and what people should provide without insurance

The executive meeting of the State Council proposed to enrich commercial health insurance products and develop insurance products for the elderly and the disabled. Accelerate the development of medical insurance and other practice insurance to increase coverage. Increase policy support. We will improve corporate income tax policies for enterprises paying employees for supplemental medical insurance premiums, encourage social capital to establish health insurance companies, and support commercial insurance agencies in establishing new medical institutions, community pensions, and physical examinations.

Song Fuxing believes that for commercial insurance companies, this is a rare opportunity for development and an important task for the times. The insurance industry should establish the concept of "big insurance" and must have people's livelihood.

First, it is necessary to enrich health insurance products and services and reduce the burden on the people. Including: focusing on the development of various types of complementary medical insurance products that are linked to basic medical insurance and guaranteeing the self-paid medical expenses, using insurance “Large Number Rules” to play a good role in sharing the medical expenses and reducing the economic burden of the insured people; at the same time, paying attention to people’s basics Health protection needs beyond health insurance provide a barrier to health risks for different groups of people; it also greatly enhances the level of health management services and attaches health management responsibilities to health insurance.

Second, we must broaden coverage and provide "big insurance" services. On the basis of basic medical insurance, we will accelerate the development of medical, disease, nursing, disability, and accidents. “The people lack what we do, and we must bear the heavy responsibility that the era has given to the insurance industry.” Song Fuxing said.

In addition, technical support must be strengthened to provide data services for the entire society. "Professional health insurance companies have a large number of residents' health data. Insurance companies can improve the data warehouse's architecture design, and strengthen data exchange with social security and medical systems, and comprehensively store and analyze customer base health, treatment, health care and other data information." Song Fuxing Said, "The medical and health data will be transformed into population disease and health information, and information search and data analysis services will be provided to the society to improve the ability of the whole society to meet future health challenges."