Commercial health insurance development space is huge to develop in multiple directions
The aging of the population in the context of the industry generally believe that the pension or the third pillar is the main asset to cope with the aging of the population. Zheng Bingwen, director of the World Social Security Research Center of the Chinese Academy of Social Sciences, pointed out that health insurance also plays a positive role in coping with the aging of the population, in response to the aging of the population in a comprehensive initiative, health insurance should be included.
Zheng Bingwen pointed out that health insurance is an important means of making up for the gap in lifelong financial security, and is an important supplemental resource for coping with population aging. 2018 U.S. medical and health expenditure per capita of about $11,000, of which 34% of the expenditure on commercial medical and health insurance. In China, health insurance accounts for only 4% of the per capita expenditure on medical and health costs, a huge difference from the 34% in the United States.
For the future development trend of health insurance, Xing Wei, President of the Insurance Association of China, said that commercial health insurance should be transformed to the direction of long-term products, diversified protection responsibilities, and hybridization. At the same time, the universality of commercial health insurance should be more prominent, and more innovative products like specialty drug insurance should be developed, so that people who really need protection can get it and afford it.
Xing Wei pointed out that the development of commercial health insurance should improve the health management model, and accelerate the transformation and extension from after-sales payment to before-sales management. Through the behavioral management of patients, product innovation, data **** enjoyment of the docking, service norms and standards construction and other ways to do a good job of risk prevention and control and related services. The industry should strengthen the development of the health care field and provide comprehensive solutions that meet the needs of the people.
Wu Xiangtian, deputy director of the planning department of the National Health Commission, pointed out that improving and perfecting the health protection system is an important part of promoting the construction of a healthy China, and is also an effective means of integrating the promotion of people's health and social development. The Healthy China 2030 plan calls for a sound multi-level medical insurance system with basic medical insurance as the mainstay, supplemented by other forms of supplemental insurance and commercial health insurance, as well as the enrichment of health insurance products, and the promotion of cooperation between commercial insurance companies and medical, medical checkup, and nursing care organizations.
Depth participation in the multi-level health insurance system, commercial insurance catalog industry calls gradually
In recent years, commercial insurance to develop a drug catalog calls more and more high. The industry generally believes that in the policy to encourage and market demand for the dual promotion of social security business insurance integration is imperative, the development of basic health insurance outside of the commercial insurance supplement catalog will become an important hand to promote the development of the industry's high-quality.
Zheng Bingwen in this year's two sessions of the proposal, it is necessary to develop a comprehensive "national commercial health insurance drugs, diagnostic and treatment items and medical supplies supplemental catalog" (referred to as "commercial insurance catalog"). The current "National Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance Drug Catalog" refers to the standards of the basic medical insurance, workers' compensation insurance and maternity insurance funds to pay for the cost of medicines, but the commercial insurance catalog is still vacant in the industry.
The State Medical Insurance Bureau mentioned in the interpretation of the "2021 National Medical Insurance Drug Catalog Adjustment Work Program" not long ago that "the solution to the accessibility of new medicines can't just rely on the basic medical insurance as a path, but also give full play to the functions of various types of supplementary insurance, commercial health insurance and other channels, and better meet the needs of different levels of medication by establishing a perfect multi-level medical insurance system with Chinese characteristics. To meet the needs of different levels of medication." This is a clear call for commercial health insurance to participate in the construction of the multi-level medical insurance system again from the perspective of pharmaceutical protection.
At the beginning of 2020, 13 ministries and commissions, including the China Banking and Insurance Regulatory Commission (CBIRC), proposed in the "Opinions on Promoting the Development of Commercial Insurance in the Field of Social Services" that the application of new medical technologies, new medicines, and new devices should be gradually incorporated into the scope of commercial health insurance coverage. The State Council executive meeting held on December 9, 2020, chaired by Premier Li Keqiang, pointed out the need to accelerate the development of commercial health insurance, to do a good job of convergence with the basic health insurance, and encourage insurance companies to include reasonable medical costs outside the health insurance catalog in the scope of protection.
Huang Hong, former vice chairman of the China Banking and Insurance Regulatory Commission (CBIRC), said at the State Council's regular policy briefing that commercial health insurance should try to cover reasonable medical expenses outside the catalog. At the same time, with the development of business such as Huimin insurance and long-term medical insurance, some insurance companies have begun to design specific drug catalogs, positive and negative lists, and some regions in China have introduced city-level out-of-pocket drug catalogs outside of health insurance.
The Secretary General of the Insurance Association of China, Mr. Jingguo Shang, said that it is necessary to study the development of commercial health insurance catalog standards as soon as possible, which will help to realize the dynamic linkage between basic health insurance and commercial insurance, *** with the same to promote the development of a multi-level protection system, and to effectively enhance the level of protection of the people's medical and health services.
Zheng Bingwen said, the establishment of commercial health insurance catalog is to promote the health insurance financing level to enhance the breakthrough, is the establishment of a multi-level health care system and multi-sectoral synergistic mechanism of the key hand, is the basic health insurance to implement the quantitative purchasing to enhance the level of payment of the pharmaceutical equipment industry is an important tool to satisfy the multilevel diversified people's health needs of the necessary complementary means.
"The drugs and consumables in the basic health insurance catalog are purchased with the largest price reduction to meet the basic social needs, while innovative drugs and innovative medical consumables can be supplied through the 'national commercial insurance catalog' to realize the integration of commercial insurance and social security." Zheng Bingwen pointed out that the "national commercial insurance catalog" as a basic medical insurance back-up directory, can alleviate the pressure of the expansion of the basic medical insurance directory, but also with the "national basic medical insurance, industrial injury insurance and maternity insurance drug directory", "basic medical insurance medical consumables directory" organic convergence, to achieve the integration of the development of the commercial insurance and social security.
CIRC lead multi-party The subject is expected to produce results in a year
To this end, CIRC led the China Health Information and Healthcare Big Data Society and China Pharmaceutical and Healthcare Culture Association in April this year,*** with the launch of the "standardization of commercial health insurance directory and the long-term development of the" subject of the study, aimed at the follow-up formal
The topic of commercial insurance catalog focuses on three major directions: First, the guiding principles and core values of commercial insurance catalog establishment, from promoting the development of the articulation of the various levels of the medical insurance system, meeting the diversified healthcare needs of the residents, and promoting the integrated development of the pharmaceutical and insurance industries, etc., to dig deep into the expected value and core principles of the establishment of the commercial insurance catalog. Secondly, we summarize a large number of experiences in the domestic practice of commercial insurance and medical insurance catalog, including the participants of the catalog, the formation mechanism, the health economics evaluation system, and the supporting system, etc., and analyze the formation process and operation effect of the relevant index system. Third, through the directory principles and experience combing, for the next step to formally promote the establishment of commercial insurance directory, put forward the construction, landing program, supporting measures and other directional recommendations, the formation of the subject of research conclusions.
Representatives from insurance companies and pharmaceutical industry consulting organizations had an in-depth discussion on the industrial value of commercial insurance directory construction, the realization of the goal, the formulation of principles and other topics in the third plenary working meeting of the Committee of Health Insurance Professionals recently. It is reported that the subject of regular closed-door seminars, invited medical, pharmaceutical, insurance and other industry representatives of the subject group, the subject of research focus on the content of the full discussion, and gradually formed industry **** knowledge.
By the Pacific Health, China Life, Ping An Life and other 18 insurance companies, a number of pharmaceutical organizations and technology consulting firms, etc. *** with the composition of the subject group, will be carried out for a period of about one year of the subject of research, the results of the subject is intended to be officially released in 2022.