On September 29, the General Office of the State Council recently issued the "14th Five-Year Plan for National Medical Security" (hereinafter referred to as the "Plan"), which proposed the reform and development goals of my country's medical security system in the next five years.
That is, by 2025, the medical security system will be more mature and finalized, and the reform tasks of important mechanisms such as benefit guarantee, financing operation, medical insurance payment, and fund supervision, as well as key areas such as medical service supply and medical insurance management services, will be basically completed.
It is reported that this is my country's first special five-year plan for universal medical insurance. The relevant measures respond to people's livelihood concerns and directly address the shortcomings of the medical insurance system, reflecting the country's emphasis on the problem of difficult and expensive medical treatment.
Among them, the "Plan" mentions encouraging the development of commercial health insurance. In assisting the construction of a multi-level medical security system, commercial insurance needs to seize three major opportunities.
The "14th Five-Year Plan" National Medical Security Plan proposes to adhere to the basic concept of insurance throughout and encourage the development of commercial health insurance. The content of the "Plan" shows that our country has built the world's largest basic medical security network covering the entire population.
During the "Thirteenth Five-Year Plan" period, my country's basic medical insurance covered 1.36 billion people, with the coverage rate stable at more than 95%. The proportion of hospitalization expense fund payment within the scope of the basic medical insurance policy for employees and urban and rural residents was stable at around 80% and 70% respectively. The national The average price of organized mass purchase of drugs and high-value medical consumables has dropped by more than 50%, and the people's sense of access to medical security continues to increase.
Although the above set of data is exciting, the "Plan" also points out that the development of my country's medical security is still unbalanced and inadequate, the multi-level medical security system is not yet complete, and the ability to protect major and serious diseases is still insufficient. Medical insurance, medical care, and pharmaceutical reforms Collaboration needs to be further enhanced, and there is a gap between medical insurance services and people's needs.
Therefore, the "Plan" puts forward the basic principles of adhering to basic guarantees and making them more sustainable.
——Insist on ensuring basic and more sustainable services.
Adhere to seeking truth from facts, do our best and within our capabilities, keep the basic concept of guarantee throughout, scientifically and rationally determine the scope and standards of guarantee, correct the problems of over-guarantee and insufficient guarantee, improve the fund's overall economic ability, and prevent and resolve fund operation risks.
It can be seen that the "14th Five-Year Plan" medical insurance plan proposes to adhere to the concept of basic medical insurance throughout, which also means that the water in the "pool" of medical insurance is limited. In the future, it is impossible for all medical expenditures to be paid for by basic medical insurance.
It is particularly important to improve the security system including commercial insurance, charity assistance, and medical assistance.
Among them, the "Plan" mentions encouraging the development of commercial health insurance.
The first is to encourage product innovation.
Commercial insurance institutions are encouraged to provide comprehensive health insurance products and services in multiple fields such as medical treatment, disease, rehabilitation, care, and childbirth, and gradually include new medical technologies, new drugs, and new equipment applications into the scope of commercial health insurance coverage.
Support commercial insurance institutions and traditional Chinese medicine institutions to cooperate in providing health management services and develop insurance products such as traditional Chinese medicine to treat diseases.
Pay more attention to the role of commercial medical insurance, guide commercial insurance institutions to innovate and improve security content, and improve security levels and service capabilities.
The second is to improve support policies.
Clarify the liability boundaries of basic medical insurance, support commercial insurance institutions in developing commercial health insurance products that are connected with basic medical insurance, and better cover expenses that are not covered by basic medical insurance.
Explore and promote information sharing between medical security information platforms and commercial health insurance information platforms in accordance with regulations.
The third is to strengthen supervision and management.
Standardize the critical illness insurance business undertaken by commercial insurance institutions, and establish and improve the performance evaluation mechanism of commercial insurance institutions participating in the handling of basic medical insurance.
Implement the responsibilities of industry regulatory authorities, strengthen market behavior supervision, and highlight the supervision of key links such as commercial health insurance product design, sales, and compensation.
In the construction of a multi-level medical security system, commercial insurance is positioned as an important participant in basic medical insurance, a major provider of supplementary medical insurance products, and a leader in the commercial health insurance market. In fact, for the "14th Five-Year Plan" medical security plan, the National Medical Insurance Administration
It was publicly solicited for opinions in September 2020; the State Council executive meeting on September 15, 2021 also mentioned again the need to improve the multi-level medical insurance system and optimize medical insurance support policies by category.