First, the development status of medical liability insurance in Shenzhen
Shenzhen medical liability insurance started its market research and development from 1999. After the business development from 200/kloc-0 to 2004, the market scale is still relatively small. At present, only PICC, Ping An Property Insurance and Pacific Property Insurance carry out this business in Shenzhen. By May 2004, the accumulated premium income of medical liability insurance business was1245,200 yuan, and the compensation expenditure was 523,400 yuan, of which Ping An Property Insurance accounted for 85.53% of the market share and Pacific Property Insurance accounted for 14.47%. Although PICC has related products and started this business, it has not signed the premium income yet.
The types and quantities of medical liability insurance products in Shenzhen are relatively scarce. As of May 2004, there are 6 medical liability insurance products sold in Shenzhen, including 2 PICC, 2 Ping An Property Insurance and 2 Pacific Property Insurance. However, there are only three types of medical liability insurance products still on sale, each of which is 1.
It can be seen that the medical liability insurance market in Shenzhen is small in scale, with little company investment and low market development enthusiasm.
Second, the existing problems and causes analysis
In the process of developing medical liability insurance in Shenzhen, many new problems and difficulties have emerged. There are some problems and difficulties in the development of medical liability insurance, such as strong professionalism of medical liability insurance, conflict of interests between doctors and patients and insurance companies, lack of historical data of medical liability insurance, and backward actuarial technology. Some problems and difficulties are unique personality problems in Shenzhen's insurance market, such as frequent disputes in Shenzhen's medical industry and the risk of adverse selection caused by uneven levels of doctors in various institutions.
(A) the lack of professional strength to develop medical liability insurance
Medical liability insurance involves a lot of professional knowledge, including medical treatment, insurance and related laws. There is a great risk of information asymmetry in developing medical liability insurance. Due to the short history of medical liability insurance, insurance companies have no relevant experience and talent accumulation. In the process of medical liability insurance development, underwriting and claims settlement, insurance companies often need the help of external forces such as medical associations, lawyers and related medical appraisal institutions. As a result, the cost of development, underwriting and claim settlement of this insurance has increased a lot.
(2) Conflicts of interest among doctors, patients and insurance companies.
Medical liability insurance involves the interests of doctors, patients and insurance companies, but the interests of the three parties are conflicting. As far as insurance companies are concerned, medical malpractice accidents lead to economic compensation losses; As for doctors, in the current environment, what I am most afraid of is the medical liability accident, which will affect the reputation and brand of my hospital and the career prospects of doctors. Therefore, hospitals and doctors are generally only willing to call them medical disputes, medical faults and medical defects, adopt a "negative" service, uncooperative or even "inaction" attitude, and do not actively adopt medical liability insurance and other means and methods to solve them; For patients, medical liability insurance often can't solve medical disputes well, because medical accidents lead to patients' death and disability, and their families not only want to get some economic compensation, but also want to be investigated for legal responsibility for medical accidents.
(3) The historical data of medical liability insurance are few, and the actuarial technology is backward.
Introducing actuarial technology into non-life insurance products is a common practice in the international insurance industry, which is scientific and effective. However, in Shenzhen and even the whole country, due to the short history of medical liability insurance, the lack of detailed historical data accumulation from the perspective of medical institutions and insurance companies, and the lack of non-life insurance actuaries in insurance companies at present, the rate determination of products in the market is still in the stage of experience rate, which is basically determined by "slapping the head" and cannot achieve personalized and differentiated services. This restricts the development of medical liability insurance business to some extent.
(4) The relevant laws and regulations are not perfect.
Medical liability insurance bears the liability of the insured according to law, so the imperfection of laws and regulations is undoubtedly an important factor restricting the development of liability insurance. Although the State Council promulgated the Regulations on Handling Medical Accidents in 2002, which stipulated that the burden of proof should be reversed in terms of whether the medical institutions were at fault, the judicial circles still have different views on whether the judgment of medical accidents was completed. As far as Shenzhen is concerned, the Measures for the Risk Management of Medical Practice Responsibility in Shenzhen has not yet been promulgated. For incidents that do not constitute medical accidents but are at fault, there is a lack of uniform standards on whether medical institutions should be liable for compensation, which leads some medical institutions to take a wait-and-see attitude towards participating in medical liability insurance. This situation increases the operational risk of insurance companies and slows down the pace of insurance companies entering this field.
With the judicial interpretation of the standard of personal injury compensation in the Supreme People's Court, the amount of personal injury compensation in medical institutions will greatly increase, and the compensation pressure of insurance companies will also increase. The Measures for the Risk Management of Medical Practice Responsibility in Shenzhen City has not yet been promulgated. The risk management of medical practice liability in Shenzhen is not systematic, and each department will introduce its own policies to compete for benefits. Shenzhen insurance company's current medical liability insurance rate is low, which will lead to greater systemic risks. It is inevitable to raise the premium substantially, which may lead to the formation of alliance between hospitals to protect themselves, further restricting the development of this business.
(E) Frequent medical disputes and high risk of adverse selection.
As a high-risk insurance, medical liability insurance business is still facing enormous compensation pressure even in western countries that have developed for decades. There are frequent medical disputes in Shenzhen, and the amount of compensation is high. For insurance companies, it means that the payout ratio and the amount of compensation will be very high. The economic benefit of Shenzhen insurance company in operating medical liability insurance is not optimistic.
On the other hand, the current medical liability insurance rate in Shenzhen has not been personalized and differentiated, and it has not formed an effective economic lever of "rewarding the excellent and punishing the poor". The risk of "adverse selection" is great, and individual medical institutions and doctors will use medical liability insurance to defraud compensation, which is not conducive to the further development of medical liability insurance.
Third, the market development potential analysis
1. The medical industry in Shenzhen is developing rapidly, and the social demand for medical liability insurance is increasing.
Shenzhen * * has 92 non-profit medical institutions at all levels, 20 out-patient departments, and more than 20 for-profit medical institutions 120, ranking first in the country, with more than 32,000 medical staff, and the compensation caused by medical accidents is about100000 yuan every year. With the improvement of people's living standards in Shenzhen, the awareness of medical care and consumer rights protection has been further enhanced. Disputes and lawsuits between patients and medical institutions occur from time to time. For example, in recent years, Diao Chunjing's beauty incident occurred in Shenzhen, and the collective infection of pregnant women in Shenzhen Women and Children Hospital. Under the objective situation that the supply and demand of the medical industry have increased substantially, with the increasing number of medical disputes, the pressure on medical workers to pay compensation is increasing, and the development of medical liability insurance has become an objective demand.
In addition, the experience of developed countries proves that medical liability insurance is helpful to reduce medical disputes. After the promulgation of the Regulations on Handling Medical Accidents in China, the scope of medical accidents has been expanded, and the fault principle of medical accidents has been clarified, which means that the market development potential of medical liability insurance is huge, and the demand of medical institutions for medical liability insurance is bound to increase.
2. Vigorously expanding medical liability insurance is an objective need for the development of insurance companies.
Liability insurance is an important part of property insurance in mature market economy countries. As early as 1970s, the premium income of American liability insurance reached more than 48% of general property insurance income, while the European market exceeded 30%, Japan reached 25%, and Shenzhen only 3.8%. Medical liability insurance is an important part of occupational liability insurance, which will not only become an important part of modern medical services, but also become a new economic growth point for insurance companies. For example, American doctors' participation in medical liability insurance accounts for 4% of doctors' annual income. According to this ratio, the premium income of medical liability insurance in Shenzhen is about 66 million yuan (according to statistics, there are 32,000 medical staff in Shenzhen, with an average annual income of 510.2 million yuan), accounting for 654.38+0.8% of the current property insurance premium income in Shenzhen (3.608 billion yuan in 2003).
Four. Development countermeasures and suggestions
Because the indemnity of the insurance company in medical liability insurance directly protects the interests of hospitals or doctors, unforeseen legal liability risks are transformed into fixed insurance premium payment. Therefore, medical liability insurance not only transfers the medical practice risks of medical institutions and doctors, but also minimizes the operating costs of medical institutions. On the other hand, this kind of compensation is paid to the injured party, which is the compensation for the patient or his family, so medical liability insurance indirectly provides a mechanism to protect the rights and interests of patients.
In addition, from the perspective of insurance companies, medical liability insurance has great development potential, which provides new impetus and vitality for the insurance industry to become bigger and stronger.
In order to seize the opportunity, reform and innovate, and accelerate the sustainable development of medical liability insurance in an all-round way, according to the unique environment and opportunities for the development of medical liability insurance in Shenzhen, the following development countermeasures and suggestions are put forward:
(1) Intensify publicity and cultivate social risk awareness and insurance awareness.
Through increasing the publicity of medical liability insurance products at multiple levels, we will raise the awareness of relevant laws and risks, correct some medical institutions' lack of objective estimation of medical occupational risks and misunderstanding of insurance protection, and expand insurance coverage. Insurers underwrite on the basis of risk assessment, which also plays a role in supervising and restraining the insured. If the management of medical institutions is chaotic and the risk is too high, the insurer can raise the rate or even refuse insurance, which will urge the insured to continuously improve the existing deficiencies and meet the standards required by national laws, regulations or rules and regulations, otherwise it will reduce its reputation in the industry, so as to play the role of social management through insurance as a market means.
(2) Strengthen the training of non-life insurance actuaries, apply and improve actuarial techniques, and develop marketable products to meet the changing demand of Shenzhen market.
China's non-life insurance actuarial has just started, and there is a shortage of non-life insurance actuarial talents. However, it is a scientific and common practice to develop products by using non-life insurance actuarial technology in the world. Therefore, strengthening the cultivation of non-life insurance actuarial talents and improving the actuarial technical level have become the necessary conditions for diversification and individualization of products and services. Shenzhen's insurance market is relatively mature and the environment for product innovation is relatively favorable. According to the needs of different medical institutions at different levels in Shenzhen, we will develop marketable products and expand the scope and depth of insurance.
In addition, insurance companies should strengthen the management level of medical liability insurance products and have more reasonable and clear ideas on the market development and operation of this type of insurance, which is conducive to the rational and healthy development of medical liability insurance.
(3) Form an effective information sharing mechanism to improve the efficiency of resolving medical disputes.
Due to the conflict of interests among medical institutions, patients and insurance companies, an effective information sharing mechanism and communication channels have been formed in the process of medical liability insurance underwriting and claims settlement, which is conducive to reducing disputes between them and improving the efficiency of solving medical disputes.
(4) Improve relevant laws and regulations and form a systematic medical liability risk management mechanism.
Only a sound system of laws and regulations can medical liability insurance be fully developed. Because the standards for handling medical disputes in the Regulations on Handling Medical Accidents and the Civil Law are not uniform, which affects the development of medical liability insurance, insurance companies communicate with health management departments, actively cooperate with and persuade the legislature and relevant departments to improve the corresponding laws and departmental regulations. For example, by formulating the Detailed Rules for the Implementation of the Regulations on the Handling of Medical Accidents, it is clear that the scope of application of the Regulations on the Handling of Medical Accidents is connected with the civil law, so as to avoid the different standards and results of insurance claims due to the choice of legal application; Formulating regional local regulations or departmental rules to adjust medical negligence-Shenzhen's measures for handling medical negligence have relevant basis for handling medical disputes caused by medical negligence other than medical accidents defined in the Regulations on Handling Medical Accidents, and so on.
(five) to speed up the development of intermediary market, make full use of intermediary power to solve the technical bottleneck of insurance companies.
The cultivation and development of the intermediary market is a systematic project, but the maturity of the intermediary market is very conducive to solving the technical bottleneck of insurance companies' underwriting and claims for highly specialized products. In the mature insurance market abroad, individual protection plans are usually made for each customer through intermediaries, or some intermediaries are specialized in brokerage consulting services for medical system insurance. In the relatively mature Shenzhen insurance market, it is an effective way to use intermediaries to help the development of medical liability insurance.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.