Huimin insurance products have developed rapidly, with 654.38+0.4 billion participants. "Huimin Insurance", as a customized commercial medical insurance project in the city, aims to solve some high medical expenses other than reimbursement of basic medical insurance. Huimin insurance products have developed rapidly, with 654.38+0.4 billion people insured.
Huimin insurance products have developed rapidly, with 65.438+40 million participants. "Huimin Insurance has received extensive participation from the government, commercial insurance institutions and third-party service platforms because of its business model. These two years have been very prosperous, and the coverage has gradually improved, which has supplemented the shortcomings of basic medical insurance. " Recently, Zhang Lin, director of the Institute of Risk Management and Actuarial Research of Hunan University, said in an interview with China Economic Weekly.
As a phenomenon-level insurance product in recent two years, urban customized commercial medical insurance (Huimin insurance for short) has developed rapidly. As of 202 1,12,31,there are 244 prefecture-level cities in 28 provinces, and 177 Huimin insurance has been launched in 22 regions,1400,000 person-times.
However, during the development of Huimin insurance, there are also problems such as nonstandard disclosure of claims information and insufficient awareness of insurance at the grassroots level.
Zhang Lin shared her views with reporters on the original intention behind the promotion of Huimin products across the country and how Huimin products across the country can participate in social governance.
It is suggested to publish the claim information of Huimin Insurance.
"The biggest feature of Huimin Insurance is Huimin. Whether it is uninsured or people with special diseases or rare diseases, they can buy Huimin insurance. Spend a year 100 ~ 200 yuan to buy a Huimin insurance (the maximum amount of insurance is 3 million), no matter what the reimbursement ratio is, it is very worthwhile for ordinary people, and it really achieves low premium and high insurance coverage. " Zhang Lin told the reporter of China Economic Weekly.
Take "Beijing Pratt & Whitney Health Insurance" as an example. Compared with other commercial insurance, its biggest feature is that healthy people and five groups of people with specific past history can apply for insurance and settle claims. In other words, if you have already suffered from major diseases such as malignant tumor, coronary heart disease and diabetes before insurance, you can still apply for insurance and claim settlement.
The explosive growth of Huimin insurance in the past two years is due to the extensive participation of the government, commercial insurance institutions and third-party service platforms in its business model.
"In addition to the price being close to the people and realizing the connection between commercial insurance and social security, the introduction of Huimin insurance products in various places is more from the perspective of reducing the out-of-pocket ratio of residents' medical and health expenses and reducing the out-of-pocket cost of people's medical treatment and medication." Zhang Lin said frankly.
She said that it is difficult to complete medical insurance alone by minimizing the out-of-pocket proportion of residents' medical expenses, and commercial insurance is the best way.
Zheng Bingwen, director of the World Social Security Research Center of China Academy of Social Sciences, believes that Huimin insurance is an institutional innovation in which commercial insurance participates in the multi-level medical insurance system, a bold exploration to hedge the high medical inflation rate of 10.7% for low-and middle-income groups and share the burden of high medical expenses, and an important practice to promote the prosperity of * * *.
Wang Guojun, a professor at university of international business and economics Insurance College, once said in an interview with China Economic Weekly that the logic of the Medical Insurance Bureau to promote universal medical insurance mainly lies in improving the level of medical insurance, developing the third pillar of medical insurance, and using commercial insurance mechanism to solve the problem of insufficient social medical insurance.
However, the "blooming everywhere" of Huimin insurance has also brought some problems. Zhang Lin admits that Huimin Insurance has no unified claims information disclosure, and the information disclosed is very limited. The simple payout ratio that can be seen on the Internet fluctuates greatly from less than 20% to 99.88%, which is not conducive to future product design and upgrade iterations.
"It is still a mystery how much out-of-pocket expenses Huimin insurance products can reduce and reduce the burden of medical treatment for ordinary people. This is my concern. A key question. I hope that commercial insurance companies can release Huimin insurance claims report. " Zhang Lin told the reporter of China Economic Weekly.
Zhang Lin suggested establishing an information disclosure mechanism for Huimin insurance. Every year, the data is disclosed to the public from the aspects of expenses, compensation and insurance, so as to enhance the public's cognition and feelings and enhance the sense of acquisition of Huimin insurance. It is suggested to delimit the expenditure scope of Huimin insurance business to prevent it from becoming "handling business" or "general but useless" if it is too low or too high.
"Insurance function" should be systematically embedded in the social governance system.
"I bought Huimin insurance myself, and Huimin insurance is more of a supplement to basic medical insurance." Zhang Lin told the reporter of China Economic Weekly.
She introduced that the development trend of Huimin insurance in Hunan is relatively good, but it is still difficult to push it up. "We still don't know enough about the credibility of Huimin Insurance and the social governance function behind it."
Take Huimin Insurance launched by Caixin Life Insurance in Hunan as an example. Changsha, Shaoyang, Yueyang and other places promote Huimin insurance products, but the underwriting rate is less than 40%. People still have many doubts about the guarantee function and product cost performance of Huimin insurance.
It is particularly important to enhance the insurance awareness of the whole society. For many years, Zhang Lin has been a researcher in the field of insurance and an advocate of reform and development in this field.
She told the reporter of China Economic Weekly: "Insurance is a tool of modern social governance, but many places lack the basic knowledge of insurance. Some local governments have not given enough promotion and support to Huimin insurance. It is necessary to publicize and popularize insurance knowledge in government management departments at all levels, so that insurance principles and risk management awareness can be deepened into the work. "
Zheng Bingwen said: "It is suggested that the National Medical Insurance Bureau issue relevant policies to support Huimin insurance."
Zheng Bingwen believes that at present, many local medical insurance bureaus hold a "neutral" attitude of not opposing or supporting, and one of the main reasons is that they have not been reassured. The statement of the central government means that the data support provided by local governments will be unimpeded, which is conducive to enhancing individual confidence in participating in insurance and improving the participation rate.
In addition, as early as 20 18, Zhang Lin, a deputy to the National People's Congress, took the lead in proposing the construction of an "insurance society".
She believes that the insurance industry is exploring various measures in the fields of serving modern society, national governance and urban governance. It is a good exploration for Zhejiang coastal provinces to participate in social governance by using insurance products such as Huimin insurance.
"It is necessary to raise public awareness of insurance through more publicity. For us in power, it is especially necessary to strengthen the practice of learning to use insurance services for social management and economic development, and embed the' insurance function' system into the' governance system', which is the proper meaning of the modernization of social governance capacity. Zhang Lin told the reporter of China Economic Weekly.
Huimin insurance products have developed rapidly, with 654.38+0.4 billion participants. 2 Open WeChat, pay attention to the official account of WeChat, fill in the insurance information and pay the order ... In less than 5 minutes, Zou Jiuhua, a citizen of Dongpo District, Meishan City, bought a Dongpo Huimin insurance with a maximum insured amount of 2 million yuan.
"Dongpo Huimin Insurance", "Rong Hui Insurance" and "Hui Chong Insurance" ... At present, 13 cities in Sichuan Province have launched customized urban commercial medical insurance, commonly known as "Huimin Insurance".
"Huimin Insurance", as a customized commercial medical insurance project in our city, aims to solve some high medical expenses other than reimbursement of basic medical insurance. Due to the low insurance threshold and low price, Huimin insurance has developed rapidly in Sichuan Province in recent years. What are the practices of the first places to launch "Huimin Insurance"? How to enter more families and benefit more people? What bottlenecks does this insurance need to break through? Recently, the reporter launched an investigation.
Changes: higher insurance coverage, more protection and service upgrade.
As an innovative attempt to build a multi-level medical security system, "Huimin Insurance" is carried out in the form of local government leading or guiding, underwriting by commercial insurance companies and voluntary participation by consumers.
Up to now, Chengdu, Deyang, Nanchong, Meishan, Guang 'an, Zigong, Panzhihua, Neijiang, Guangyuan, Ya 'an, Yibin, Dazhou and Suining 13 cities have launched this business, with premiums ranging from 59 yuan, 69 yuan and 79 yuan, and the maximum coverage ranging from10 to 4.2 million yuan.
"In 2020, the number of participants in the first year of Chengdu Huirongbao will reach 365,438+10,000." Wang Jianguo, one of Huirongbao's underwriting companies, the legal person of Bao Guo Life Insurance and the deputy general manager of the government business department, told the reporter that Huirongbao is the first "Huimin Insurance" in Sichuan, and the number of insured persons has increased year by year in recent two years. 202 1, and the total number of participants reached 3.8 million.
Compared with last year, the "Huimin Insurance" launched in some cities this year has been upgraded-
The insured amount is higher. Nanchong's "Chonghuibao" insurance coverage increased from 6.5438+0 million yuan in the previous year to a maximum of 2 million yuan, and the new 6.5438+0 million yuan guarantee responsibility was a specific high drug fee, which made up for the gap in the previous year; The maximum insured amount of "Dahuibao" in Dazhou increased from 6.5438+0 million yuan last year to 4.2 million yuan.
More protection. Nanchong "Chonghuibao" added 20 kinds of high-priced drugs at its own expense, while Suining "Huisuibao" increased the number of specific drugs from 15 to 30 under the condition that the premium price in 59 yuan remained unchanged in 20021year.
The service is better. At present, almost all the "Huimin Insurance" launched adopts the method of "one-click insurance online claim settlement", and the claim settlement can realize the whole online service.
The threshold for claims is lower. The deductible lines of Chengdu Huirongbao, Suining Huisuibao and Dazhou Dahuibao have all been reduced. Taking "Huisui Insurance" as an example, the deductible for payment was reduced from 20,000 yuan to 6,543.8+0.8 million yuan, and the deductible for continuous insured personnel was reduced to 6,543.8+0.5 million yuan.
Suggestion: Multi-participants should strengthen cooperation to stabilize and improve the enrollment rate.
Tens of dollars can protect millions, there is no limit to the age of insurance, and you can also be insured even if you are sick ... On the morning of April 9, although the staff of an insurance company spent more than 20 minutes introducing "Huimin Insurance", Zhang Yu gave up insurance. "Personal feelings are not particularly significant."
Take the actual claim settlement case of two people talking. In 2020, Aunt Zhou, an 84-year-old Chengdu citizen, was hospitalized for "replacing a pacemaker", resulting in medical expenses of 65,000 yuan. After being reimbursed by medical insurance, the personal medical expenses are 24,000 yuan. After leaving the hospital, she submitted an application for compensation, and received nearly 1 1,000 yuan from Huirongbao.
Although Aunt Zhou's compensation far exceeds the premium paid, some citizens, like Zhang Yu, think that the actual compensation amount is less than expected and their willingness to participate in insurance is not strong.
The participation rate is not high, and the sustainability of this insurance is also affected. "Stabilizing and improving the participation rate is the key to the sustainable development of Huimin Insurance."
According to Mu, Secretary General of Guangyuan Insurance Industry Association, it is necessary to guide the insured to correctly understand "Huimin Insurance", which is not only a supplement to building a multi-level medical security system, but also an innovative move to effectively link commercial insurance with social insurance, which can further reduce the burden on the masses, especially the family burden of patients with serious diseases. "Huimin insurance" does not conflict with other commercial insurance, and the price is relatively low, which is more inclusive.
For how to stabilize and improve the participation rate, Yang, an insurance lecturer at the School of Management of Beijing Union University, suggested: firstly, expand the coverage of the insured; Secondly, insurance companies should strengthen information exchange and communication with hospitals, health committees and other systems, and improve the risk control ability of "benefiting the people" by means of science and technology; Finally, insurance companies, health management companies and other participants in "Huimin Insurance" should strengthen cooperation, provide effective medical security for residents according to local conditions, improve health management capabilities, and meet more needs of consumers.
"If it becomes more and more expensive, it will lead to more low-risk people withdrawing from the market." Chen Dongmei, an associate professor in the Insurance Department of Fudan University School of Economics, believes that only if the pool of insurance funds is large enough can it be more effective to spread risks. "Since it is a customized medical insurance in the city, we should reasonably determine the rate according to various risk factors such as the actual prevalence rate of the city and the incidence of serious diseases, and realize' one city, one price'."
Huimin insurance products have developed rapidly, with 654.38+0.4 billion participants. 3 Beijing Jinghui Insurance, Hangzhou Citizen Insurance, Wuhan Bao Hui Insurance ... In recent years, urban customized commercial medical insurance has blossomed everywhere.
Sun Jie, member of Chinese People's Political Consultative Conference and vice president of university of international business and economics Insurance Research Institute, said that to promote the sustainable development of Huimin Insurance and give full play to its positive role, we need to start from many aspects, focusing on solving the adverse selection of Huimin Insurance, the operating enthusiasm of insurance companies, product positioning and other issues.
She suggested that the relevant institutional mechanisms of "Huimin Bao" should be improved. Strengthen the top-level design, clarify the qualification standards of business participants, and improve the entry and exit mechanism, break-even subsidy mechanism, cross-regional service settlement mechanism, and performance evaluation mechanism. To ensure the long-term sustainable operation of the "Huimin Bao" project.
Wang Zhen, a professor at the Graduate School of Chinese Academy of Social Sciences and a master tutor, believes that the key to a stable and far-reaching policy of "benefiting the people" lies in "drawing a clear line and defining responsibilities", and the customized commercial medical insurance in cities should not be turned into "the second medical insurance". It is necessary to strengthen "political and business cooperation", assist commercial insurance companies to do a good job in publicity, provide handling services and network platforms for "Huimin Insurance" and incorporate them into one-stop settlement platforms. Strengthen supervision to avoid major social risks.
Zhang Xiaodong, founder and CEO of Maxim's Health, suggested that the drug list and reimbursement rules of Huimin Insurance should be further refined to help commercial insurance companies better carry out pre-actuarial and risk control. I hope that more upstream and downstream enterprises will participate deeply in the future and help promote the sustainable development of Huimin Bao in many ways.
Integrate and cooperate to build a multi-level health security system
The 2022 government work report proposes that this year we should effectively protect and improve people's livelihood and strengthen and innovate social governance. Insist on doing our best, do what we can, constantly improve the service level to the public, and strive to solve the people's livelihood problems that the people are generally concerned about.
"Protecting the people" is an important link in building a multi-level health security system. Secretary-General insurance association of china also mentioned that the emergence of "Huimin Insurance" provided enlightenment for the integration and cooperation of social security and commercial insurance. Commercial insurance should recognize its own positioning and advantages, optimize product design, and meet people's diverse health protection needs. Commercial health insurance provided by insurance companies is only an integral part of health insurance supply, not the whole.
Basic medical insurance, health management, hospitals, medicine, etc. Each part can not complete the supply of high-quality health insurance independently, so it needs close cooperation. The effective circulation of the whole health insurance industry ecosystem can promote the development of many health-related industries, but only if buyers and suppliers can promote each other.
Zhang Xiaodong introduced that "Huimin Insurance" can help commercial insurance companies to carry out in-depth cooperation with medical insurance-related units, medical institutions and pharmaceutical companies, truly participate in the relatively high insurance field in payout ratio, improve the situation that commercial insurance companies have been lacking data support, and also provide basic support for product design and optimization. I hope that "Huimin Insurance" will become an important link between medical insurance and commercial insurance in the future.
Break the "data island" and let "Huimin Bao" continue to benefit the people.
Sun Jie believes that it is necessary to solve the insurance "data island" problem and build a data information sharing platform. It is suggested that the information exchange channels among traditional medical institutions, basic medical insurance institutions and commercial insurance institutions should be opened in accordance with the principles of ensuring users' privacy, minimizing usability and data desensitization, so as to promote the data sharing between medical insurance and commercial insurance, and provide data support for the accurate positioning, pricing, iterative evolution and optimal combination with other commercial insurance products to achieve accurate guarantee.
The development of commercial health insurance is inseparable from the long-term accumulation of data. Zhang Xiaodong believes that it is necessary to further integrate the data of the medical industry and the insurance industry. It will further derive the benefits of Huimin Insurance, comprehensively design products according to the special needs of China's "home insurance", reduce the risk of adverse selection, optimize the way of claims, and provide more convenient one-stop claims service for the masses.
Xue Mei, an associate professor in the Department of Insurance of Beijing Technology and Business University, believes that "Huimin Insurance" should take several measures to continuously benefit the people: First, the positioning of "Huimin Insurance" should benefit the people, and the scope of cities can be increased on the current basis, expanding outward from a specific field, not limited to a specific city, satisfying the law of large numbers in insurance management, thus dispersing risks;
Second, as a commercial insurance product, "Huimin Insurance" needs both technical support and data support to lower the price and make it easier and more convenient for the public to insure. Third, insurance companies should constantly improve their service level, technical level and cooperation level, and use the savings from insurance intermediaries, commissions and channels for the prevention and treatment of diseases, which is also a manifestation of benefiting the people.