The Zhanjiang model refers to the introduction of commercial insurance into the social security system. Through large-amount supplementary insurance provided by insurance companies, the masses receive greater protection without paying a penny more.

The separation of government and enterprises has been truly achieved, and cooperation between government and enterprises has been achieved at a higher level.

In January 2009, Zhanjiang City's new rural cooperative medical insurance and urban residents' medical insurance were integrated into the operation, which solved the problems in the past caused by the disparity in payment standards and different levels of coordination between the two medical insurance systems, such as low enthusiasm for insurance participation and weak fund adjustment capabilities.

In order to further improve the situation such as cumbersome medical insurance reimbursement procedures, uneven allocation of medical resources, and high government management costs after the "merger", Zhanjiang City decided to introduce commercial means to provide integrated management and services for basic medical insurance and supplementary medical insurance for urban and rural residents.

——By establishing an "integrated consulting service platform", the insurance company provides policy consulting services including basic medical care, supplementary medical care, health management, commercial health insurance and other policy consulting services to the city's residents; by establishing an "integrated payment and settlement platform", the insurance company can realize patient diagnosis and treatment expenses

Settlement information is shared among insurance companies, social security departments and designated hospitals.

"Zhanjiang Model" was selected into the Financial Times' "Top Ten Insurance News in China in 2010" In the selection of "Top Ten Insurance News in China in 2010" announced in December 2010, PICC Health's "Zhanjiang Model" was selected as the insurance industry's contribution to the construction of the national medical security system.

A typical sample was selected as the first item in the top ten news items - "The insurance industry has made important progress in participating in the construction of the social security system through various models."

The jury commented that as the government actively improves people's livelihood and further strengthens the construction of the social security system, the insurance industry has emerged with the "Zhanjiang Model", "Yixing Model" and "Jinjiang Model". Local governments and commercial insurance institutions have actively cooperated to develop the insurance industry.

Commercial insurance institutions play an indispensable and important supplementary role in basic medical insurance, new rural pension insurance, and new rural cooperative medical services.

The essence of the "Zhanjiang Model" is co-location. Through co-location, a one-stop management service platform for basic medical insurance and supplementary medical insurance has been established. Health insurance companies provide medical management, document review, etc. for basic medical insurance.

Professional services reduce the management personnel and operating costs of the social security department, improve administrative efficiency and public service levels, optimize medical and health resource management, improve operational efficiency and service quality, and enable limited medical resources to be reasonably and adequately utilized.

Utilization has achieved "complementary advantages, seamless links, and win-win cooperation" between the social security department, the company, and designated hospitals. It is known as a successful practice and typical example of the insurance industry serving the construction of the national medical security system.

The central government fully recognizes the value and significance of the "Zhanjiang Model" in transforming government functions, leveraging the professional and efficiency advantages of third parties, and innovating public service delivery methods. It will undoubtedly guide all sectors of society to pay more attention to research from the institutional and mechanism levels.

The active role of the insurance industry in serving the new medical reform will strive for greater policy support for the promotion of the "Zhanjiang Model".

Since Zhanjiang City cooperated with the Zhanjiang Central Branch of China People's Health Insurance Co., Ltd. (referred to as PICC Zhanjiang Central Branch) to promote the reform of the urban and rural medical security system in July 2008, the "Zhanjiang Model" has achieved remarkable results after more than three years of operation.

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First, it improves the efficiency of medical insurance management and standardizes medical behavior.

The integrated management service platform enables insured people to receive one-stop services.

Through the restriction and supervision of medical services, in 2009, "run, risk, drip and leakage" funds were reduced by 69.08 million yuan.

Second, it improves the efficiency of resource allocation and reduces people's medical expenses.

Through differentiated minimum payment standards and reimbursement ratios, insured persons are guided to seek reasonable medical treatment, the distribution of disease sources is balanced, and the rational use of medical resources is promoted.

From January to September 2010, there were 367,000 hospitalizations in the city, an increase of 69.9% compared with before the system merger; the per capita hospitalization expenses within the scope of basic medical care were 3,019 yuan, 628 yuan lower than before the system merger; the per capita payment of the unified fund was 1,748 yuan, which was 1,748 yuan more than before the system merger.

An increase of 24.3%; the average reimbursement rate reached 57.9%, an increase of 19.3% compared with before the integration of the system.

Third, through the integrated information platform, we have innovated the direct settlement of medical expenses of insured persons and the prepayment settlement mechanism of medical insurance funds.

The latter has reduced the long-standing phenomenon of arrears in medical expenses, and in particular, primary medical institutions such as township health centers and community hospitals have obtained a stable source of funding.

Fourth, it reduces government administrative costs and improves public service levels.

Zhanjiang City has reduced relevant staff and can save more than 8 million yuan in government expenses every year.

The "Zhanjiang Model" has achieved a win-win situation in which all parties including the government, hospitals, people, and commercial insurance companies benefit.

The essence of the "Zhanjiang Model" is that the specific cooperation method between Zhanjiang City and the Zhanjiang Branch of the People's Insurance Company of China is to continue to use 85% of the original personal payment part of the basic medical insurance for urban and rural residents for basic medical insurance expenditures (managed by the social security department), and withdraw 15%

Purchase large-amount supplementary medical insurance services from PICC Health.

While the individual payment standards remain unchanged, based on different payment levels (payment levels are divided into two levels: 20 yuan and 50 yuan), on the basis of the original basic medical insurance limit of 15,000 yuan, the insurance amount is greatly increased, and the cumulative reimbursement amount reaches

80,000 yuan and 100,000 yuan.

First, it is driven by the government.