How to understand the third-party manager of health insurance?

Originated in the United States, it refers to an independent third-party insurance intermediary that conducts business in the form of health management companies and consulting companies, including providing new contracts and security services, handling claims, providing customer service, and developing medical service networks. Compared with the traditional insurance intermediaries-brokers, agents and claimants, TPA is more powerful as a third-party service provider. It is independent of the supply and demand sides, and has no direct upstream and downstream value relationship and organizational direct relationship with the insurer and the insured. Due to the existence of the third party nature between the insurer and the insured, the necessary conditions for the survival and development of TPA are: 1. Professionalism, that is, not only to provide professional services, but also to provide services in areas other than insurance supply and demand; 2. Contractual, that is, this third-party relationship is protected and bound by legal norms, and TPA and the service recipient * * * conduct activities within the framework of the contract; 3. Value-added, which is also the business core of TPA, that is, in every link of contract performance, service recipients must realize value-added TPA. These unique characteristics also ensure its great advantages in the health insurance market. In some developed countries, third-party management has become a mature and practical risk management service. In the health insurance market, it has become an indispensable part. However, in China, despite all the benefits, there always seems to be obstacles in the process of TPA's "China". In 2008, Swiss Reinsurance Company and American Wellpoint Insurance Company successively announced the establishment of TPA Company in China, followed by the establishment of Shanghai Wan Xin by European company MobilitySaintHonoré. The background of local enterprises is only Yuan Meng and Jian Kang Green Channel Rescue Alliance. Two years later, while most people in China are participating in social basic medical insurance, the efforts of foreign health insurance giants to intervene in the domestic health insurance market have not made much progress, and most of them have not yet achieved profitability. The fundamental reason for China's slow development and embarrassing situation lies in the great difference between the domestic medical system and foreign countries.