First, a correct understanding of the current situation facing the development of health insurance
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At present, the development of health insurance is indeed facing some difficulties, the development model is unclear, the life of professional health insurance companies is not easy, and even some comrades still lack enough confidence in the development of health insurance. But we must see that the current development of health insurance is facing a rare development opportunity:
(A) The report of the 17th National Congress fully affirmed the important role of health insurance.
In the just-concluded report of the 17th CPC National Congress? Accelerate the establishment of a social security system covering urban and rural residents to ensure people's basic livelihood. Accelerate the improvement of the social security system based on social insurance, social assistance and social welfare, focusing on the basic pension, basic medical care and minimum living security system, supplemented by charity and commercial insurance. ? The report of the 17th National Congress of the Communist Party of China highly affirmed the important position and role of the insurance industry in improving the social security system, pointed out the direction for the development of health insurance, and will certainly play a great role in promoting the development of health insurance. It can be said that the more the economy develops, the more important social security is, and the health insurance closely related to social security will usher in a rare development opportunity.
(2) The reform of the medical and health system has pointed out the development direction of health insurance.
Since August 2006, the insurance industry has actively taken advantage of the opportunity of participating in the national working group on medical and health system reform to strengthen coordination and strive for more space and a better environment for the development of commercial health insurance. At present, the medical reform is coming to an end, which provides favorable conditions for the development of commercial insurance. Program requirements: we should actively develop commercial health insurance and encourage commercial insurance institutions to develop health insurance products that meet different requirements to meet high-end and diverse health needs. Establish a multi-level medical security system and encourage enterprises to solve their needs beyond basic medical security by participating in commercial insurance. Encourage commercial insurance to participate in social insurance management, and use market mechanism to improve the management and service ability of social medical insurance.
(C) Social demand has provided great impetus for the development of health insurance.
Whether an industry can develop depends on whether there is social demand, and social demand is an important force to promote the development of health insurance. The society has a wide and diversified demand for health insurance, and with the development of social economy and the improvement of people's living standards, people's requirements for health insurance will be higher and higher. From the experience of foreign countries, both the absolute value and household consumption of health insurance expenditure will be higher and higher, which is an inevitable development trend. Compared with the extensive and sustained growth of social demand, the supply capacity of health insurance industry is far from enough, and there is still a lot of room for development of health insurance.
Two, correctly handle several problems in the development of health insurance
(A) scientifically establish the market positioning of health insurance.
The market positioning of health insurance has been clearly defined in the medical reform plan. First, vigorously develop personalized products and provide high-quality health insurance services to meet the high-end and diversified medical security needs of high-end people. The second is to provide high-quality products and services to meet the health protection needs above basic insurance. Third, actively and steadily participate in social insurance handling business. It is a common practice for the government to spend money on services abroad, and it is also a development trend of the transformation of government functions in China. In recent years, commercial insurance has made active and effective explorations in providing social insurance handling services. These explorations are conducive to improving the visibility of the insurance industry and establishing the image of the insurance industry serving the overall situation and being brave in taking responsibility; It is also conducive to improving the voice of the insurance industry in institutional coordination. However, the participation of medical insurance in social security management should follow the principle of positive and steady, and we should not rush headlong into it. If conditions permit, you can go where the government understands; Where the conditions are not met and the government does not recognize it, we should be cautious. Companies with conditions and many branches can do some; Companies that don't have the conditions and few branches don't have to do it. Handling business is very policy-oriented, so be cautious when going in, and be more cautious when going out.
(two) to explore the development law of health insurance and lay a solid foundation for the development of the industry.
Through the exploration in recent years, we have a clear understanding of the operating rules of life insurance and endowment insurance. Under the guidance of these business rules, the current life insurance business ideas are clear, the solvency is sufficient, and the development is basically on the right track. Old-age insurance, especially enterprise annuity, started hard, but now the development situation is also very good. The business of two professional pension insurance companies has expanded rapidly, and they have great advantages in the enterprise annuity market. In contrast, the development of health insurance is still difficult, and the life of some health insurance companies is still difficult. It is an important task of health insurance industry to actively study and explore the development law of health insurance and strive to improve the management level of health insurance. Not only the CIRC should study the development law of health insurance, but also the whole industry, including companies and academia.
(three) to study and formulate the disease incidence table, improve the scientific pricing of medical insurance.
The compilation of life table plays an important role in the scientific pricing and healthy development of life insurance. Due to the lack of basic data such as disease incidence, the pricing of health insurance lacks scientific basis, which is very blind, and the phenomenon of vicious price competition among individual companies for business also occurs from time to time. It is of far-reaching significance and fundamental role to study and formulate a scientific disease incidence table to promote the healthy development of health insurance.
(D) We should correctly handle the specialization and diversification of health insurance development.
The main participants in the health insurance market include professional health insurance companies, property insurance companies and life insurance companies. Different types of companies should give full play to their respective advantages and have different positioning. Professional health insurance companies should work hard on specialization and develop products different from property insurance companies and life insurance companies. Property insurance companies and life insurance companies can combine health insurance products with their main business, and give full play to the brand effect and resource advantages of their main business.
For the development of health insurance products, we should overcome impetuous psychology, give full play to the protection function and health management function of health insurance, do a good job in product and market development, and provide high-quality health insurance services for the society.
Third, unify understanding and promote the sustainable development of business.
(1) Strengthen policy coordination and create a more favorable development environment.
At present, the main body of health insurance market is still immature, and the right to speak health insurance is small. At the same time, the regulatory authorities should properly coordinate some policies to create a good external environment for the development of health insurance. However, for the coordination work, the regulatory authorities should also keep a clear head, do what they can and make steady progress. For some temporary problems with unclear laws, immature development conditions and high risks, we can sum up experience in a timely manner through pilot projects and make steady progress, instead of doing it all at once.
(2) Standardizing competition and maintaining a good market order.
Competition is the basic feature of market economy, and price competition is the most important means of competition in many fields. However, due to the particularity of health service, the competition of health protection should be more reflected in the competition of service quality than the competition of price. From the company's point of view, the competition of health insurance should not only be limited to low-level price competition, but also consider how to improve the service quality of health insurance. From the perspective of regulatory authorities, we should guide companies to compete in service quality, avoid vicious price competition regardless of cost, establish and protect a good image of health insurance, and safeguard the interests of the industry.
(3) Strengthen the protection of consumers' rights and interests and establish a good image of health insurance.
At present, the regulatory authorities should put the protection of consumers' rights and interests in a more prominent position, and earnestly strengthen the supervision of acts that harm consumers' legitimate rights and interests. Now many companies use health insurance to sell? Wide in and strict out? This practice has brought many problems, such as last year's problems? Critical illness insurance storm? . Insurance companies should reconsider selling insurance products? Wide in and strict out? Practice, change? Wide in and strict out? For what? Yan Jin Kuan Chu? Do not mislead when selling, explain the problem clearly to the insured, so that the insured can have a full understanding and psychological preparation for the insurance purchased. In the compensation stage, we should try our best to meet the compensation requirements of the insured. When introducing their work experience, the heads of some foreign-funded insurance companies I contacted all mentioned that more standardized foreign companies should follow suit? Yan Jin Kuan Chu? For the insurance sold in principle, when claims occur, the compensation need not be reported to the general manager, but the refusal to pay compensation should be reported to the general manager. This correct idea and effective practice of protecting consumers' rights and interests abroad deserves our serious consideration and reference. We should be aware of the need to gradually establish? Yan Jin Kuan Chu? The new health insurance sales model will be very beneficial to establish a good image of the health insurance industry.
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