On March 15, in order to further improve the policies and measures for family doctor contract services and promote the high-quality development of family doctor contract services, the National Health Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, the State Medical Insurance Bureau, the State Administration of Traditional Chinese Medicine and the State Disease Control Bureau recently jointly issued the Guiding Opinions on Promoting the High-quality Development of Family Doctor Contract Services.
Because the family doctor contract service has the fundamental attribute of taking the residents' health as the center, the family as the unit and the community as the scope, it is an important starting point for promoting the construction of "Healthy China" in the mainland and promoting the realization of the goal of providing residents with all-round full-cycle health services. Since the family doctor contract service was launched nationwide in 2016, the exploration path of the reform in terms of appropriateness and standardization has gradually become clear, and has been recognized and welcomed by the masses. In 2020, the full coverage of the family doctor contract system was basically realized. However, there are still some factors that restrict the development of family doctor contract services. It mainly includes that the financing mechanism for contracted services is not perfect, the supply capacity of contracted services is insufficient, the signing method needs to be optimized, and the incentive for family doctors to carry out contracted services is insufficient. These problems need to be gradually solved through reform to ensure the high-quality development of family doctor contract services.
In recent years, insurance companies have been working hard in the fields of insurance + health, insurance + medical treatment, trying to improve user stickiness by providing more services to customers in the field of medical health, while expanding their own service margins, and family doctors are actually a very good entry point, insurance companies can provide more multi-level and diversified services. Today we will talk about what opportunities domestic insurance companies have in the family doctor process and what they should do.
Family Doctor: An important link between the company, the patient, and the hospital, and the health management in the field
The family doctor profession originated in general medicine in the United States, called primary care physician in the United States, and called them "primary care doctors" in China, with more than 250,000 people, accounting for more than half of the doctors in the United States, and almost penetrated the national medical system. They can accurately write out the medical history of customers, and can rescue seriously ill people, pneumonia, myocardial infarction, pulmonary embolism, stroke, etc. Therefore, the family doctor is neither an "all-round doctor" nor a "dragonfly water" type of light consultation doctor, but a professional doctor who can help patients connect more medical resources.
In China, we usually have a medical record in hand, and when we are unwell, we will go to the hospital and queue up to see a doctor. In the United States, the medical files of patients are stored in everyone's "family doctor". Whether to see a doctor, when to see a doctor, and whether to see a doctor are not only in the hands of the patient, but also in the hands of the doctor.
The root cause of this discrepancy lies in the hierarchical diagnosis and treatment system and the two-way referral system implemented in the United States. U.S. private medical insurance mainly includes PPO and HMO two categories, according to the requirements of the U.S. insurance policy, patients who purchase HMO insurance must first find their own family doctor, if the family doctor deems it necessary, the patient will be referred to a specialist for further examination, diagnosis and treatment; If the condition requires hospitalization, the family doctor or specialist will contact a partner hospital to transfer the patient to treatment; When the condition is relieved, the patient is referred back to the doctor's office for follow-up consultation.
The biggest difference in buying PPO insurance is that you can directly see a specialist without going through a family doctor referral. Nonetheless, the vast majority of PPO clients have found their own family doctors and prefer them to assist with referrals, thanks to the important role that family doctors play in the U.S. healthcare system.
The U.S. graded diagnosis and treatment model
At present, the mainland medical system is quite different from that of the United States, and the domestic medical security system is based on basic medical security, supplemented by other forms of supplementary medical insurance and commercial health insurance, so the role of family doctors has been relatively weak.
Specifically, in the 1980s, the concept of family doctors began to be introduced into China, and since 2016, family doctors have begun to fully implement the stage, mainly with community health service centers as the fulcrum for family doctor contract services, as of 2018, the number of mainland community health organizations has grown to 9352.
Map of the number of community health organizations in the mainland
However, due to the huge population base of the mainland, the low amount of per capita medical resources, and the medical system with social security as the absolute pillar, the family doctor model currently used in the mainland is based on the community medical service center as the fulcrum to radiate the service to the population within the community radius. We must face up to the current gap between the mainland and developed countries in Europe and the United States in terms of per capita medical resources, and these gaps also provide some opportunities for commercial insurance companies to do family doctors, and insurance companies must also learn to "adapt to local conditions" and find a family doctor path that conforms to the current situation of the mainland.
Domestic insurance companies target "family doctors" and provide closed-loop services before and after diagnosis
In fact, many companies in China have begun to pay attention to the family doctor business, as a pioneer in the reform of the domestic insurance industry, Ping An has taken the family doctor as an important part of its new medical and health model, Ping An said in the annual report: deepen strategic upgrading, innovation and exploration of "HMO + family doctor + O2O" as the core of the group management medical model.
We take Ping An Health, a subsidiary of Ping An, as an example, Ping An Health is the flagship platform of Ping An Group's medical and health ecosystem, and is also an important part of Ping An Group's "HMO Managed Medical Model", in terms of medical service capabilities, Ping An Health positions the family doctor team as "account manager who understands medical treatment", reaches users and helps users generate exclusive medical and health files, providing users with timely and high-quality online medical services.
Specifically, first of all, after the user purchases the family doctor membership, Ping An Health will provide exclusive family doctors, and then, according to the user's needs, match the resources of the five major scenarios of health management, sub-health management, disease management, chronic disease management, and pension management, generate an electronic file covering the whole life cycle, and finally, coordinate and arrange medical and health-related services from online to offline.
For example, when a user with a chronic disease registers as a member, Ping An Health Family Doctor will screen and predict chronic diseases and complications for the member through guided assessment, so that the user knows the risk in advance.
The family doctor then develops a chronic disease improvement program, providing more than 1,300 recipes and more than 200 exercise programs through the advice of fitness coaches, nutritionists, and psychological counselors.
For members who need to enter the treatment process, the family doctor will connect with online and offline chronic disease medical services, including online remote diagnosis and treatment and offline hospital triage, guidance, special doctor diagnosis and treatment, hospitalization arrangement, second diagnosis of famous doctors, rehabilitation nursing, etc.
After entering the treatment period, the family doctor will follow up with the treatment, not only tracking the health signs, assessing the risk value, but also regularly checking and updating the user's treatment plan.
In addition to Ping An, insurance companies such as Taiping, Taibao, Fuxing United and other insurance companies have a layout in this field, and the project mainly provides users with online consultation, offline diagnosis and treatment green pass and other services to meet the needs of users' diagnosis and treatment in an all-round way.
The existence of family doctors is essentially to build a communication bridge between the supply and demand sides, eliminate the information asymmetry in the medical and health market, and improve the user experience.
For insurance companies, medical health is an area that has been the focus of efforts in the past few years, because only by fully connecting medical health and insurance can the identity of insurance companies be changed, that is, from a simple payer to the user's health manager, and the family doctor is actually a perfect gripper.
From the perspective of demand, home care or family doctors are the best point of force
And the best incision entrance for family doctors, we think is the elderly who live at home. At present, many self-built nursing home projects of insurance companies have begun to slowly land, but in fact, the elderly that can be covered by this pension model are very limited, the reason is that the rate is often higher, and it is more suitable for China's pension model or home care.
Providing more medical security services for the elderly at home is a market with greater imagination. At present, many insurance companies have also launched home care projects, of which family doctors are one of the important services.
Taking Sunshine Life's "Filial Piety worry-free" comprehensive solution for the elderly as an example, the product takes the customer-exclusive family doctor service composed of "AI + full-time doctor team" as the core, supplemented by the nursing service provided by the professional nurse team, the drug distribution service supported by the efficient logistics system and the nutrition solution service specially customized by the expert team, to build a health management system of medical and nursing linkage, medical integration and medical care integration, and protect the health of elderly customers.
Among them, "medical and nursing linkage" refers to providing customers with comprehensive health diagnosis, through basic sign examination, basic disease collection, family disease collection, medication collection and collation and other means to make a comprehensive health assessment of the customer's health status, and issue risk reminders, diet and exercise suggestions, offline medical treatment and other programs to escort the health of elderly customers.
"Medicine in One" launches a 7 * 24 hours one-click video diagnosis and treatment service, using online electronic prescription to provide customers with offline drug delivery services, to ensure 365 days of uninterrupted medical integration services.
"Combination of medical and nursing care" is a professional team composed of Traditional Chinese and Western medicine experts, senior nutritionists and senior nutrition consultants, customizing nutrition solutions according to the customer's physical condition, and realizing the cold chain distribution of nutritious meals, providing customers with one-stop solutions in diet and nutrition.
If the pension project of the self-built nursing home is aimed at high-net-worth elderly customers, then the current home-based pension plan launched by the insurance company can help the insurance company to further penetrate into the real needs of the elderly group, help expand the service margin and user stickiness of the insurance company, and the family doctor is an important starting point for reaching the needs of this part of the elderly group.
Conclusion: Objectively speaking, due to the great difference between the medical insurance systems of the mainland and European and American countries, it is difficult for the family doctors launched by domestic insurance companies to play a similar role in the diagnosis and treatment systems of European and American countries, but in the context of demand and service-driven, domestic insurance companies can still use the family doctor as a gripper to provide customers with better services.
Especially in the past two years, the team of agents has shrunk sharply, and the insurance business has declined in the context of the decline of new policies, health management has become the direction of the insurance division to bet heavily, but in fact, from the financial reports of the major insurance companies, only the number of people covered by the health management business has been disclosed, and the health management has not formed a large enough positive feedback for the sales of new orders, so how to grasp the users and tap out the greater demand for health management is what the insurance companies need to think about in the next stage, and the family doctor is a very good gripper.
Of course, Baosi as a family doctor also puts forward higher requirements for its own medical layout, and this is also what many Baosi are doing in the past few years, similar to Ping An, Taikang, etc., have made a lot of progress in the construction of doctor teams and hospital resources, since there are resources, we must pay close attention to the use.
Finally, we also expect baoshi to actively develop a grip like "family doctor" to complete an important part of product reform and reverse the decline in the development of new orders.