New Medical Reform Improves Health Insurance Mechanism Health Insurance Contains Business Opportunities

Health insurance companies and hospitals in depth cooperation, or shares in hospitals, and even independent construction of the hospital in the future will become the mainstream trend.

Recently, the "Opinions of the State Council on Deepening the Reform of the Pharmaceutical and Health System" (hereinafter referred to as the "Opinions") and the "Implementation Plan of the Medical and Health System Reform in the near future (2009-2011)" have been issued one after another, making a new change in the industry quiet. Occurs and investment opportunities in the health industry are highlighted.

In addition to the traditional pharmaceutical fields, such as generic drugs, medical devices, pharmaceutical commerce, biopharmaceuticals, Chinese medicine, and hospitals, there are investment opportunities in the three major areas of health insurance, medical information, and health education. Business.

The "Opinions" pointed out: "Encourage commercial insurance institutions to develop health insurance products that meet different needs, simplify claims procedures, facilitate people, and meet diverse health needs. Encourage businesses and individuals to solve basic problems by participating in commercial insurance and various forms of supplementary insurance. Needs beyond medical security."

In the next 10 years, China will gradually establish a universal medical insurance system supplemented by basic medical insurance for urban workers, medical insurance for urban residents, and rural cooperative medical insurance, which means that there are huge business opportunities in the field of health insurance.

Since 2005, the China Insurance Regulatory Commission has successively approved several specialized health insurance companies such as PICC Health, Ping An Health, Kunlun Health and Ruifu Health. According to the data released by China Insurance Regulatory Commission, from January to November 2008, the premium income of these four health insurance companies alone reached 13.95 billion yuan, a sharp increase of 614% from the same period last year. Only PICC Health Insurance had a premium income of 13.686 billion yuan. According to a well-known foreign health insurance company forecast: by 2015, China's health insurance premium income will exceed 120 billion yuan, showing that China's health insurance market is rapidly expanding.

Although the health insurance market has great potential, because the threshold for operating health insurance business is relatively low, except for a few professional health insurance companies, non-professional insurance companies such as life insurance companies and property insurance companies can also operate. In addition, strong foreign insurance companies have continued to join in, and the competition is fierce. In addition, the health insurance business has a higher payout ratio and the profit margin is smaller than that of general life insurance products. As a result, many insurance companies usually just bundle them as additional products and bundle them with life insurance or wealth management products. What's more, the pre-medical reform policy is not clear, which further increases the difficulty of the professional development of health insurance companies.

At present, the new medical reform has pointed out the development direction of health insurance: the supplement of basic medical care is aimed at high-end and high-end people, which clears the way for the development of health insurance companies.

The "Opinions" pointed out: "On the premise of ensuring the safety and effective supervision of the fund, we will actively promote the purchase of medical security services by the government, and explore entrusting qualified commercial insurance agencies to handle various kinds of medical security management services."

With the gradual implementation of the “division of management and management” of the medical insurance fund, the social medical insurance institutions are also facing changes themselves. By introducing third-party health insurance companies, they can give full play to their “catfish effect”: on the one hand, they will help improve the social insurance institutions. Operational efficiency and service levels; on the other hand, provides health insurance companies with a rare opportunity to enter the basic medical insurance field.

The "Opinions" also pointed out: "Improvement of medical practice insurance, the development of medical social work, the improvement of medical dispute resolution mechanisms, and the promotion of communication between doctors and patients." This means that the purchase of medical practice insurance by doctors or hospitals may soon become a reality.

Doctors are a high-risk profession. In the event of a major medical accident, hospitals and doctors will face huge claims. Under the legal restraint of "prompting proof of inversion" in medical malpractice, doctors have a tendency to lead patients to over-examine in order to ensure that they are in an advantageous position in litigation, which is one of the reasons for the tension between doctors and patients.

In the United States, practicing doctors are obliged to purchase occupational risk insurance. Doctors no longer have to bear the responsibility for economic compensation. Patients can claim economic claims directly from insurance companies. Therefore, in the course of the entire profession, American doctors get their personal and property interests. Better protection.

According to rough statistics, there are more than 6 million medical personnel in China. Once all doctors are required to purchase compulsory medical insurance, this will create a huge market. For insurance companies, from now on, we should actively develop medical insurance products that suit China's national conditions in order to seize opportunities.

Health insurance companies and hospitals in-depth cooperation, or shares in hospitals, and even independent construction of the hospital in the future will become the mainstream trend, through in-depth cooperation with the hospital, health insurance companies on the one hand to obtain complete and accurate patient information, design a suitable product, Reduce the cost of claims; on the other hand, you can also get a lot of customer resources.