The commercial health insurance market is gradually entering a period of rapid development

The commercial health insurance market is gradually entering a period of rapid development

“Huimin Insurance”, which has sprung up like mushrooms, will face regulatory requirements for standardized development. Critical illness insurance products will enter a new and old shift period, and 10-year and 20-year long-term medical insurance will come out one After another. Recently, new changes in the health insurance industry are emerging. The successive introductions of favorable policies have become the reason behind its premium. Being able to deeply participate in the construction of a multi-level medical security system is not only the expectation of the public for commercial health insurance but also an inevitable need to ease the financial burden of government medical insurance. However, to achieve this goal, health insurance still needs to “strengthen the body”, solve the problem of insufficient supply of personalized products, make health management services truly play a role, and use technology to promote the transformation of the “insurance” + service” business model.

Behind the explosive growth of premiums

Health insurance “strengthen the body” participates in the construction of the multi-level medical insurance system

In recent years, driven by policy incentives and market demand, my country’s commercial health insurance market has gradually entered a period of rapid development. From 2011 to 2019, the compound annual growth rate of commercial health insurance was as high as 34%. Compared with the average annual growth rate of 13% for life insurance and 12% for property insurance in the same period, health insurance can be described as a “dark horse” in the entire category of commercial insurance. The COVID-19 epidemic in 2020 has accelerated the explosive growth of the health insurance market. In the first three quarters, total health insurance premium income reached 666.6 billion yuan, an increase of 17.4% over the same period last year, far exceeding the industry growth rate of 7.2%.

However, it is undeniable that behind the rapid growth of commercial health insurance, there is still an insufficient supply of personalized products. How health insurance can deeply participate in the construction of a multi-level medical security system through “strengthening the body”, perhaps in the recent new changes in the market, the answer can be found.

Strengthen the deep integration of “insurance + medical care”

In March this year, the “Opinions on Deepening the Reform of the Medical Security System” issued by the State Council proposed that by 2030, the basic medical insurance as the main body, medical assistance as the foundation, supplementary medical insurance, commercial health insurance, charitable donations, A medical security system with mutual medical assistance and common development. The proposal of the reform goal points out the direction for how the rapidly developing commercial health insurance can help improve the medical security system.

In recent years, my country’s medical and health expenditure has continued to increase. The 2020 OECD health care data shows that in 2018, the Chinese government’s health expenditure accounted for 56% of the total health care expenditure. Over the past decade, China’s health care Spending has outpaced nominal GDP growth by 5 to 10 percentage points. As spending grows faster than income, the government health insurance fund surplus will shrink.

Huang Hong, vice chairman of the China Banking and Insurance Regulatory Commission, said at the China Health Insurance Forum recently that commercial health insurance is a key link in improving the medical insurance system. “Encouraging enterprises and individuals to purchase commercial health insurance can form a diversified investment mechanism shared by the government, enterprises, and individuals, ease the government’s investment burden and financial pressure, and ensure the stable and sustainable operation of the medical insurance system. At the same time, commercial health insurance and basic medical insurance complement each other. It can meet the multi-level, diversified, and personalized health security needs of the people.”

Insurance companies do not participate enough in the construction of a multi-level medical security system. An important reason is that my country’s medical insurance system has great restrictions on the acquisition of medical information and data by commercial insurance institutions, resulting in the inability of commercial insurance institutions health insurance to deeply participate in the management and control of medical expenses. In response to this, the National Medical Insurance Bureau recently responded that it will actively explore the establishment of an information sharing and exchange mechanism. On the premise of ensuring information security and personal privacy protection, relying on the national government information sharing and exchange platform to achieve medical insurance and medical-related information. Information sharing between commercial insurance agencies and other units.

According to the reporter’s understanding, the Shanghai Insurance Exchange and the Shanghai Health and Health Commission have tried to cooperate through resource integration. The Shanghai Insurance Exchange actively supports participation in medical reform and explores the insurance cost control mechanism; the Shanghai Health and Health Commission uses Advantageous resources to support health insurance. innovation and development, and promote the establishment of the “insurance + health service” model. At present, such medical and insurance integration projects are still being implemented.

Insufficient supply of commercial health insurance

It also needs to be hard on its own. While seeking to establish in-depth cooperation with medical insurance, commercial health itself still has some shortcomings that need to be filled.

Although the growth rate of the commercial health insurance market is considerable, the performance of professional health insurance companies is not satisfactory. In the whole year of 2019, half of the six professional health insurance companies were not profitable, and among the three companies with positive operating profits, CPIC Allianz Health only made a profit of more than 40,000 yuan for the whole year.

The person in charge of a professional health insurance company admitted to reporters that the reasons for the company’s losses are various. Except for the lack of professionalization of operations and the low degree of intelligence in risk control methods, the products on the supply side are operated in a “pan-life insurance” manner, with a single structure and homogeneity. Seriously, it is a long-term “pain point”. According to the observation of the “Financial Times” reporter, although there are many health insurance products on the market, they tend to be homogeneous.

In Huang Hong’s view, the most prominent problem of my country’s commercial health insurance is the lack of supply capacity. “The development of health insurance products for minors and the elderly is lagging, and the problem that the insurance you want to buy cannot be bought or cannot be bought has not been fundamentally resolved.”

Taking the current health protection needs of the elderly, which cannot be ignored, there are two main problems. One is that the supply of products that are truly tailored to the physical condition and risk characteristics of the elderly is less, and the exclusivity is not strong; the other is that the premium is expensive. , the leverage between premiums and coverage levels is not high. Zhu Minglai, a professor at the Department of Insurance, School of Finance, Nankai University, believes that in the future, some long-term security products should be developed to meet the security needs of the elderly, rather than simply relaxing the age limit based on short-term insurance and conventional products.

After the outbreak of the epidemic, the problem of insufficient innovation in commercial health insurance has become particularly prominent. The relevant person in charge of the China Banking and Insurance Regulatory Commission previously stated that there is still room for further improvement in the insurance industry for risk protection such as large medical expenses caused by large-scale epidemic diseases. The insurance industry must increase product research and development for specific emergencies and specific groups of people.

Format changes focus on long-term security

The “Huimin Insurance” that has sprung up like mushrooms will meet the development norms, the critical illness insurance products will enter the new and old shifting period, and the 10-year and 20-year long-term medical insurance will come out one after another… The recent changes in the health insurance format are no less than the growth rate of premiums.

As a typical representative of accelerating the exploration of new health insurance development models in various places, “Huimin Insurance” is not limited to age, occupation, and even allows insurance with illnesses so that some rigid needs of sinking markets and sinking populations can be met. This project is a positive innovation to help build a multi-level medical security system. It is reported that the China Banking and Insurance Regulatory Commission has also recently solicited opinions from the industry on how to regulate insurance companies to carry out such urban customized commercial insurance business, hoping to promote their rational operation, continuous protection, and bring more benefits to consumers.

“The regulators are very concerned about the sustainability of medical insurance.” Zhang Liguang, head of medical insurance pricing at French Reinsurance Beijing Branch, said that the price of “Huimin Insurance” products launched in various places is currently very low, and life insurance companies are more willing to stand in the long-term. Look at this business from a sustainable perspective. Zhang Liguang revealed that some areas are already discussing making “Huimin Bao” products with 3-year and 5-year periods.

The definition of critical illness insurance has also recently ushered in “new regulations”, the coverage is further expanded, the payment conditions are more reasonable, and the citation standards are more objective and authoritative. At the same time, the 2020 edition of the Critical Illness Table compiled for the first time a reference table for the incidence of two representative diseases of the elderly under the “New Regulations” for critical illnesses, which is beneficial to the innovation and supply of insurance products.

Various recent changes have shown that the supply side of health insurance is constantly innovating, both in terms of guarantee period and rationality. Several life insurance and health insurance companies have begun to operate long-term medical insurance products, effectively avoiding the risk of the inability to renew the insurance due to changes in the assured’s health status or the suspension of insurance companies’ products, thereby solving consumers’ worries.

Overall, with the advancement of the Healthy China Plan and the enhancement of national health awareness, commercial health insurance will stand on a higher development platform in 2020. Consumers are more willing to pay for “health” than ever before, and health insurance companies should also strengthen refined services such as health management, medical treatment, and claims settlement in personalized products.

From “marketing-driven” to “service-driven”

The “insurance + service” model of health insurance will enter a period of rapid development

Recently, news about the dividends in the health insurance market has been coming out, which has made people in the industry very excited.

According to the “Opinions on Promoting the Development of Commercial Insurance in the Field of Social Services” jointly issued by 13 ministries and commissions including the China Banking and Insurance Regulatory Commission, the health insurance market will exceed 2 trillion yuan by 2025, and 6 trillion yuan will be accumulated for the insured by 2025. Yuan endowment insurance liability reserve. According to the above target market, the compound growth rate of pension and health insurance will reach about 20% from 2020 to 2025. In the future, health and pension products and services will become an important focus of the pension insurance system. The huge market demand and continuous policy support will promote the rapid development of commercial pension insurance.

Epidemic awakens public health insurance needs

According to data from the China Banking and Insurance Regulatory Commission, the original premium income of health insurance in the first nine months of this year reached 666.6 billion yuan, a year-on-year increase of 17.4%. , the proportion of health insurance increased to 18%. The rapid development of the health insurance industry is inseparable from many favorable factors.

In 2019, the China Banking and Insurance Regulatory Commission issued the “Administrative Measures for Health Insurance”, which pointed out that health insurance is an important part of the national multi-level medical security system, and adheres to the protection attribute of health insurance. In April this year, the China Banking and Insurance Regulatory Commission issued the “Notice on Issues Concerning the Adjustment of Rates of Long-term Medical Insurance Products”, which solved the institutional obstacles that plagued the development of medical insurance by introducing a rate adjustment mechanism, and conveyed a positive signal to encourage the development of long-term medical insurance. , which is conducive to providing consumers with insurance products with longer protection periods and more comprehensive protection responsibilities, and better meeting consumers’ long-term health protection needs.

Recently, the “Report on the Development of Commercial Health Insurance in the Post-epidemic Period in 2020” released by the Insurance Association of China shows that in the first half of 2020, the commercial health insurance industry has experienced the impact of the new crown pneumonia epidemic, and the products, channels, operations, etc. Actively responding to various aspects, professional health insurance companies quickly adjusted their business strategies, life insurance, and pension insurance companies made steady progress, property, and casualty insurance companies have a strong growth momentum, and the industry as a whole has achieved good growth. improved.

Under the definition of “service attributes”, the logic behind the launch of a series of health insurance products is also changing. In the eyes of industry insiders, my country’s insurance industry is undergoing the evolution from “marketing-driven” to “service-driven”, and the business model of “insurance + service” in health insurance may usher in a period of rapid development.

The head of the health insurance business of an insurance company told reporters optimistically: “If the average annual growth rate is 25%, in 2020, health insurance premiums will reach more than 800 billion yuan, becoming one of the three major business types that keep pace with property insurance and life insurance. one.”

Critical illness insurance remains the largest in the health insurance market

According to statistics, the commercial health insurance currently sold in the insurance industry includes five categories: disease insurance, medical insurance, medical accident insurance, nursing insurance, and disability income loss insurance, with a total of more than 5,000 products. Among them, critical illness insurance and medical insurance dominate.

On November 5, the Insurance Association of China and the Chinese Medical Doctor Association officially released the “Specifications for the Use of Disease Definitions for Critical Illness Insurance (2020 Revision)”, which improved and expanded the original 25 types of serious diseases to 28 types of severe diseases and 3 types of serious diseases. Mild illnesses with moderately extended coverage. This is the release of a new definition of critical illness insurance after 13 years, and it also brings a new outlet to the critical illness insurance market.

Relevant data show that in the past 11 years, critical illness insurance has provided consumers with more than 3,000 products, with a cumulative coverage of nearly 200 million people. “Critical illness insurance will still be the insurance with the largest absolute total in the next five years.” According to industry forecasts, due to the simple, straightforward, and easy-to-sell products, it has a high new business value rate and stable cash flow for insurance companies. Illness insurance will still be dominated by the marketing channel of life insurance and will become the type of insurance with the largest absolute growth in the health insurance market.

Wang Jian, the chief analyst of the financial industry of Guosen Securities, believes that the current health insurance problems include three aspects: first, the structure of health insurance premiums is dominated by critical illness insurance, supplemented by medical insurance; second, due to the lack of basic data, product design capabilities need to be Increase, there are hidden dangers in pricing, and insurance companies’ risk control capabilities are also limited; third, product homogeneity is serious, and existing product health management services are mainly positioned to promote sales, which are difficult to meet customers’ real health management service needs.

“The long-term medical insurance market has broad prospects for development. With the encouragement of policies, insurance companies are expected to design more long-term health insurance products to meet consumers’ needs in the future, and smooth profits through rate adjustment. It is expected that health insurance will continue to maintain rapid growth.” Liu Xinqi, the chief analyst of Guotai Junan’s non-banking financial industry, said.

Technology’s “transformation” of health insurance should focus on the middle and backstage

The intervention of insurance not only solves the problem of low-frequency communication between insurance companies and customers but also brings triple changes in user experience, channels, and marketing to the insurance industry, bringing insurance back to its essence. After purchasing health insurance, users can obtain long-term health promotion and health improvement, so that the role of insurance is no longer just a “payer” after the fact.

During the epidemic, many insurance companies adopted a business model combining “online + offline” to further enhance the ability of insurance companies to participate in health management. Customers inquire about health issues through online consultation and other methods, which overcomes the characteristics of low-frequency purchases of insurance products, allowing insurance companies to maintain communication with consumers and provide health management services.

“At the level of traditional health insurance services, affected by factors such as information asymmetry and weak medical cost control capabilities, insurance companies have almost no say in the management and cost control of medical services, and their main role is only reflected in claims settlement .” There are insurance companies The person in charge of health insurance told reporters that if online consultation based on preventive medical technology provides disease answering, assessment, and health guidance, it can help enhance consumers’ health awareness, thereby improving consumers’ health management level and reducing insurance coverage. The company underwrites risks and claims costs.

Given the many problems existing in the health insurance value chain, the application of insurance should not be limited to the marketing link but should transform the entire business process through technical means to improve business efficiency. In the eyes of industry insiders who have been deeply involved in health insurance for many years, the current “reform” of health insurance by insurance is not thorough enough, and more important application scenarios should focus on the middle and back offices. Despite the strong growth of my country’s health insurance market, the road of exploration will continue.

Health Insurance: “Manage” Your Health

People’s attention to health can be seen from the data of the soaring health products during the “Double 11”. According to Tmall’s “Double 11” data, the turnover of medical services such as physical examinations and vaccines increased by more than 1500%, and health food such as vitamins increased by more than 1600%; data from Suning Tesco also showed that nourishing bird’s nest increased by about 20 times, meal replacement light food An increase of 290%, health appliances such as sterilizers increased by 543%…

People’s emphasis on health is also reflected in the choice of health insurance products. More consumers not only value price but also whether health insurance can make them healthier.

Almost meaningless health management service

Judging from the current health management services attached to health insurance, it is still far from the desire of consumers to be “healthier”.

“Existing health management services are difficult to enter the full life cycle of customer health management, and it is difficult to improve customer recognition.” Wang Jian, an analyst at Guosen Securities, said that at present, insurance companies mainly position health management services as additional services to promote sales. Common health management services include health consultation, physical examination, genetic screening, a green channel for serious illness, overseas rescue, overseas medical treatment, etc. Among them, health information push, online consultation, health questionnaires, and other health consultation occupy the vast majority.

Wang Jian believes that the additional health management services of health insurance are out of touch with insurance, such as overseas rescue, overseas medical treatment, etc., due to the low frequency, it is difficult for consumers to recognize.

For health management services, regulators have repeatedly issued documents to promote their development and create a more relaxed environment. In 2012, the former China Insurance Regulatory Commission issued the “Notice on Matters Concerning the Provision of Health Management Services by Health Insurance Products”, which for the first time stipulated that insurance companies can provide health management services in health insurance products.

In 2019, the China Banking and Insurance Regulatory Commission promulgated and implemented the “Measures for the Administration of Health Insurance”, which specially set up the content of “health management services and cooperation”, and increased the proportion of health management service fees in health insurance premiums from 12% to 20%. Basic rules for institutions to carry out health management services.

In September this year, the China Banking and Insurance Regulatory Commission issued the “Notice on Regulating Insurance Companies’ Health Management Services”, which clarified what health management services are, that is, insurance companies monitor, analyze and evaluate customers’ health, intervene in health risk, and control the occurrence of diseases, Develop and maintain healthy factors behaviors, including health checkup, health consultation, health promotion, disease prevention, chronic disease management, medical services, rehabilitation care, etc. In addition, the purpose of insurance companies to provide health management services is to reduce the incidence of diseases and improve the health level by preventing the occurrence of diseases, controlling the development of diseases, and promoting the recovery of diseases.

Measured by this purpose, the health management services of insurance companies are almost meaningless.

Disease risk management that cannot be bypassed

Of course, more and more insurance companies provide customers with health management services, which have played an active role in enriching the connotation of health products, improving people’s health, reducing medical expenses, and improving the level of professional health insurance services. For insurance companies, under the current situation that it is difficult to achieve differentiated development of products, health management services have become one of the ways to add luster to products.

Regulators are also taking this into account. The person in charge of the relevant departments of the China Banking and Insurance Regulatory Commission said that at present, the health management business carried out by the insurance industry is still in the initial stage of development, and a mature service model has not yet been formed. problems, and even alienated into customer acquisition tools and means.

“At present, the industry mainly regards health management as a tool to increase customer stickiness and value-added services, but ignore the role of health management in cost control.” Ding Junfeng, vice president of Taikang Online, believes that this is because commercial insurance companies used to underwrite health care. For the health management of healthy people, neither the customer nor the insurance company will benefit significantly.

Under such a positioning, health management services are difficult to meet the real needs of consumers, and it is difficult to help consumers obtain the best health benefits. However, Ding Junfeng told the “Financial Times” reporter that in the past, health insurance products were mostly payment-type. As long as the customer suffered from the contracted disease, the insurance company paid immediately. Therefore, the effect of reducing the compensation through health management is not obvious. However, in recent years, the rise of compensatory health insurance products represented by “Million Medical Insurance” has made insurance companies more and more willing to control expenses through health management. In addition, the proportion of sick customers among the insured customers of Huimin Insurance and Million Medical Insurance has increased. How to manage the health of sick customers has become an important issue affecting the long-term operation of China’s commercial health insurance.

Exploring the “Management” of Insurance Companies

Although health management is a win-win situation for all parties, it is not easy to make customers willing to be “managed”. Why should customers be “managed” by insurance companies?

“Because of profit-driven and anxiety-driven.” Chen Chi, assistant general manager of the Health Management Department of Taikang Online Health Insurance Division, further explained to the Financial Times reporter. For example, doctors can provide patients with irreplaceable services. , patients are willing to be Doctor “tube”. Insurance companies can pay for their customers’ medical expenses, and thus gain a sense of trust. In this case, customers are willing to talk to us about their health issues and are willing to be “managed”.

Judging from the practice of Taikang’s online disease management system, it is effective to “manage” the unhealthy people who have already settled claims, which is effective in reducing the recurrence rate of this group of diseases.

Chen Chi cited such a real case. A 57-year-old male patient, the Tang, was admitted to the hospital for acute myocardial infarction. At the same time, the Taikang online disease management system was automatically triggered to conduct an acute coronary syndrome (ACS ) risk assessment for Tang. The evaluation results showed that Tang still belonged to a high-risk group, so he was invited to join the coronary heart disease management plan.

What health management services can I get by joining the coronary heart disease management plan? The data shows that effective control of blood pressure can prevent the recurrence of coronary heart disease. Tang Mou first received a blood pressure meter that can return blood pressure data. In addition, Tang will be regularly followed up. During the follow-up, Tang said that he had symptoms such as headache, dry mouth, and easy choking after eating. In response to these obvious symptoms of sleep apnea syndrome, he received a remote sleep screening device. It was finally confirmed that it was indeed sleep apnea syndrome, which is also a high-risk factor for the recurrence of coronary heart disease. Identifying and controlling these high-risk risks greatly reduces the recurrence rate of coronary heart disease in patients.

It is understood that Taikang Online has launched management plans for lung cancer, breast cancer, coronary heart disease, special drugs, and sleep preliminary screening, providing health management services for tens of thousands of patients. Next, there will also be diseases with higher compensation amounts from insurance companies and better health management effects to be “managed”.

“Health management services should be differentiated and scenario-based.” Specifically, Wang Jian believes that on the product side, insurance companies should provide segmented products. The customer base will expand from healthy people to people with sub-health and chronic diseases. At present, such products for segmented groups are relatively scarce. With the increase of differentiated needs of customers, such products for segmented customers will be gradually promoted. On the service side, insurance companies should expand in the direction of the full cycle. With the expansion of the population covered by health insurance, consumers who originally met the standard of rejection are expected to be covered, and at the same time, they can also enjoy personalized health management services. For example, chronic disease insurance products are provided for patients with chronic diseases such as diabetes and hypertension, combined with chronic disease management services. Insurance companies can provide patients with chronic disease management services such as indicator monitoring, medication guidance, lifestyle intervention, and emergency warning.

About article_publisher

Check Also

improve credit

Improve Credit and Reach Your Financial Goals

Introduction:  A good credit score is essential for achieving financial success and stability. It opens …

Leave a Reply

Your email address will not be published. Required fields are marked *