For a long time, commercial health insurance has been hindered by high payout ratio. On the one hand, it is difficult to see a doctor, it is expensive to see a doctor, and it is difficult to reimburse. On the other hand, it is not sick to see a doctor, and one person is insured, and the whole family takes medicine. Various phenomena and problems cast a shadow over the development of commercial health insurance.
The main reason is that commercial health insurance companies can't intervene in the customer's medical management process, and can't control the unreasonable expenditure of medical expenses, which leads to health insurance companies generally falling into a strange circle of paying for risk losses and declining product quality. As the primary risk of commercial health insurance operation; ; Because medical information resources cannot be shared, medical risk management and control has always been a difficult problem.
In fact, in the context of the implementation of the new medical reform plan one by one, in order to further improve the medical conditions of residents and improve the level of security, the information platform between social security institutions and designated hospitals has been basically unblocked, and the urban and rural social security population has basically realized real-time settlement of medical expenses. However, due to the lack of smooth information platform among commercial insurance companies, medical institutions and social security institutions, the insured who has participated in basic social medical insurance and commercial health insurance often need to see a doctor once and submit an expense account twice, or the hospital can report the loss. This not only makes it inconvenient for patients to settle medical expenses in real time, but also affects the enthusiasm of the insured, and is not conducive to the risk management and control of medical institutions by commercial insurance companies.
Second, open up information channels for tripartite development.
According to statistics, in 20 1 1 year, China's commercial health insurance premium income is 691700,000 yuan, accounting for 7. 1% of the total personal insurance premium, which is far lower than the current proportion of foreign mature markets. At present, China's commercial health insurance includes four types of insurance, namely, sickness insurance, medical expenses insurance, nursing insurance and disability insurance. However, many people are not enthusiastic about buying medical expenses insurance, and even ignore the sales of nursing insurance and disability insurance.