Because the current social medical insurance system in China is not perfect, the compensation scope and payment limit of medical expenses are limited. In this case, hospitalization allowance insurance, high medical expenses insurance and critical illness insurance in commercial health insurance can play a very good supplementary role. At the same time, for farmers in some rich areas, hospitalization insurance and comprehensive medical insurance in commercial health insurance can also be used as alternative tools for social medical insurance to provide necessary health protection for the above groups. At present, the real dilemma of the development of commercial health insurance in China is unclear role positioning. Although PHI, a commercial health insurance in China, undoubtedly exists as a supplement to SHI, it obviously has not played its due role.
Development Status of Commercial Health Insurance and Comparison of Main Products
1. Germany. Generally speaking, if a country's social insurance system is completely sound, its commercial insurance system will be negatively affected to some extent. However, the commercial health insurance in Germany is not limited by the coverage and depth of its social health insurance. On the contrary, in 2006 alone, the premium income of commercial health insurance in Germany reached 266 1 billion euros, accounting for 1.8% of the premium income of commercial health insurance in Germany, which was much higher than the market share of commercial health insurance in China (5.46% in 2007) and reached 20 1. On the other hand, Germany's commercial health insurance products are also very rich, and the coverage is relatively comprehensive. At present, long-term care insurance, income security insurance, medical expense insurance, critical illness insurance, comprehensive medical expense insurance and health insurance during travel are the best in the market, and the comprehensive medical expense insurance is the largest in business scale.
2. Britain. Britain's NHS system has covered nearly 99% of the population, and the development space of commercial health insurance is relatively small, but the market positioning of commercial health insurance in Britain is very accurate, mainly providing high-end medical services for high-income people. Commercial health insurance provides a variety of health insurance products, including commercial medical insurance, health fund plan, dental insurance, critical illness insurance, income loss insurance and so on. At present, the expenditure of commercial health insurance accounts for about 16% of the total health insurance expenditure.
3. Australian private health insurance in Australia, as a supplement to its public health security system, mainly exists in the form of mutual aid organizations such as health funds. At present, about 6,543,800 Australian residents have purchased commercial health insurance, accounting for about 45% of the total population. Commercial health insurance accounts for about 7% of national health expenditure, second only to the United States, the Netherlands and other countries. Its products mainly appear in the form of hospitalization insurance and additional insurance. The former guarantees inpatient medical services provided by public and private hospitals, while the latter mainly guarantees dental, vision correction, home care and other medical services.
4. America. At present, there are thousands of insurance companies operating commercial health insurance business in the United States, and the premium income accounts for about a quarter of the life insurance premium income. In countries where the health insurance market is mature, the types of products are often rich, and the insured can choose the products suitable for them according to their own needs, mainly including group, family and individual commercial health insurance. 5. China. During the Eleventh Five-Year Plan period, the growth rate of health insurance premium in China was 16.76%, which was about 8 percentage points lower than that of insurance premium and 10 percentage point lower than that of life insurance premium. Last year, China's health insurance premium income was 69172127,700 yuan, accounting for 7. 12% of life insurance premium income, far below the corresponding level in developed countries. In 2003, with the participation of property insurance companies, the number of business entities of commercial health insurance increased rapidly. Some companies began to set foot in the fields of disability income loss insurance and long-term care insurance, and some companies began to provide third-party management services for the new rural cooperative medical system. Major diseases, additional hospitalization subsidies and other products have formed a certain scale in China, and there are few types of products with high medical care costs.
Comparison of business models of commercial health insurance
Because medical insurance needs strong professional operation and maintains the continuous stability of operation, professional operation is undoubtedly the development direction of health insurance. From the successful experience of foreign countries, commercial health insurance is mainly operated by life insurance and professional health insurance companies, and can also be operated by accident insurance companies or property insurance companies.
1. Business model of foreign commercial health insurance. German legal system has clear regulations on the operation of commercial health insurance, which must be operated separately from other insurance businesses. At present, there are 46 professional commercial health insurance companies in the German market, many of which have been operating for decades. For example, as the largest commercial health insurance company in Germany, the German health insurance company has a history of more than 80 years. On the other hand, Germany's commercial health insurance market has entered the stage of monopolistic competition, with most of its business concentrated in the hands of a few companies, and the overall business scale has grown relatively steadily and slowly. The business entities of American commercial health insurance market are diversified. The participating operators include non-profit management medical organizations (HMO, PPO), non-profit health insurance companies (BC, BS), for-profit insurance companies and professional health insurance companies. It is worth noting that in recent years, HMO-managed medical organizations have developed rapidly among various health insurance plan providers. Australia's commercial health insurance business model is also very distinctive. By the end of 2009 10, there were 37 funds in the Australian private health insurance market. These 37 funds provide more than 3,000 kinds of health insurance products for the Australian public, and 10 of these 37 funds is for profit. Although the number is small, they account for nearly 70% of the market. Their competitive strategy is not to adopt the usual price competition strategy, but to provide different products for market segments.
2. China commercial health insurance business model. In September, 2006, China Insurance Regulatory Commission promulgated the first regulation of commercial health insurance department in China, Health Insurance Management Measures. According to Article 7 of this regulation, "life insurance companies and health insurance companies established according to law may engage in health insurance business with the approval of the China Insurance Regulatory Commission. ? Insurance companies other than those mentioned in the preceding paragraph may engage in short-term health insurance business with the approval of the China Insurance Regulatory Commission. " At present, China's commercial health insurance business is mainly operated by life insurance companies and also by property insurance companies. There are only five professional health insurance companies in China: PICC Health, Ping An Health, Kunlun Health and Harmony Health Insurance Company. Professor Chen Tao suggested that insurance companies should adopt the business model of setting up special health insurance departments within life insurance companies as soon as possible. In addition, we should actively explore the possibility of establishing professional health insurance companies. With the continuous maturity of China's commercial health insurance market, some qualified companies can also adopt the business model of health insurance subsidiaries. Because of the unique advantages of hospitals or other organizations providing health insurance directly to customers, they should actively explore and conduct in-depth follow-up research. In addition, Professor Chen Tao suggested that commercial health insurance in China has the following different organizational forms and business models to choose from. In fact, different health insurance business models should have their own advantages and disadvantages. The key to which mode we choose is to operate and manage this kind of business according to the development law of health risks and health insurance itself. For example, professional health insurance companies, property insurance companies and life insurance companies should make different positioning according to their own advantages. Professional health insurance companies should make a fuss about specialization and develop products different from property insurance and life insurance companies. Property insurance and life insurance companies can combine health insurance products with their main business and give full play to the brand effect and resource advantages of their main business.
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It can be predicted that the future national health insurance system in China must be a comprehensive and diversified system including social medical insurance, commercial health insurance and other health financing compensation mechanisms. Commercial health insurance does not necessarily play a leading role in it, but it must exist as an important part of the national health insurance system. (Author: Wu Shan Unit: School of Insurance, Southwestern University of Finance and Economics)
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