Encourage the design of long-term medical insurance to welcome changes

The top-level design once again focuses on the sustainability of Huimin Insurance. On December 24, a reporter from Beijing Business Daily learned that recently, the State Administration of Financial Supervision and Administration and the National Medical Security Administration jointly drafted the "Notice on the Smooth and Orderly Development of Urban Customized Commercial Medical Insurance" (Draft for Comments) (hereinafter referred to as the "Draft for Comments"). Many "new ideas" such as exploring and opening up part of the medical insurance data, strengthening the management of tripartite institutions, and encouraging the design of long-term medical insurance with adjustable rates have attracted much attention.

About 300 million people have participated in the insurance, and a total of more than 280 products have been launched...... While Huimin Insurance ushered in a blowout development, it also gained a lot of "troubles". In the eyes of industry insiders, for all parties, including the industry and insurance companies, it is urgent to solve the development pain points of Huimin Insurance in recent years, aiming to make a forward-looking paving for the design of long-term products and long-term operating products.

How to be more "perfect"

The sustainability of the phenomenal product Huimin Insurance has been frequently put on the table. How to solve the problem and where to start has become the number one problem faced by the industry.

Recently, the State Administration of Financial Supervision and Administration and the National Healthcare Security Administration jointly drafted the Draft for Comments, and solicited opinions from local governments. The Draft for Comments is drafted from various aspects such as improving support measures and strengthening standardized operations.

According to the Consultation Paper, local medical insurance departments shall, on the premise of complying with relevant laws and regulations, desensitizing and declassifying data, ensuring fairness and justice, and signing confidentiality agreements with insurance companies, explore the provision of part of the basic medical insurance summary statistics to the insurance companies to be involved in the application during the design period of the customized medical insurance protection plan, for the purpose of determining insurance liabilities and determining insurance rates, on the premise of complying with relevant laws and regulations, desensitizing and declassifying data, ensuring fairness and justice, and signing confidentiality agreements with insurance companies.

The recommended list of medical insurance statistical summary data includes the number of people enrolled in basic medical insurance, the total number of hospitalizations, the reimbursement cost of basic medical insurance, and the amount of medical assistance. The data time period is the last three years.

Data is the lifeblood of an insurance product. On the one hand, insurance companies are inseparable from data to design and manage customized medical insurance products more accurately, and on the other hand, it is also inseparable from data-driven to standardize the development of urban customized commercial medical insurance and ensure its sustainability.

However, for a long time, the industry has called for the need to promote the interconnection of medical insurance data and insurance data in order to truly realize the effective connection between basic medical insurance and Huimin Insurance, so as to provide a basis for the pricing risk control and responsibility design of Huimin Insurance products.

"The birth of a Huimin insurance is inseparable from data support. Therefore, the relevant data can be shared with the insurance company in a reasonable form, which can achieve better assistance for the insurance company in designing products. Xu Yuchen, a senior actuary, said that from the perspective of insurance pricing, generally speaking, there is no need for individual data, and from the number of people insured by basic medical insurance, the total number of hospitalizations, the reimbursement cost of basic medical insurance, the amount of medical assistance, etc., the data can be provided in different scopes and dimensions, which can better help insurance companies design products, in addition, the long-term stability of the product will also be guaranteed.

The reasonable sharing of basic medical insurance data can help insurance companies assess risks and costs more accurately, and then provide consumers with more intimate and appropriate insurance products. Based on this, Zhu Keli, founding dean of the National Research Institute of New Economy, said that if this measure is implemented, it will promote the refinement and personalization of insurance products to meet the diverse needs of different groups of people, improve the risk management and control capabilities of insurance companies, reduce the risk of compensation, so as to reduce premiums to a certain extent and benefit more consumers, and promote the deep integration of medical insurance and commercial insurance to form a closer health security network.

How to be more "sustainable"

How to retain people is also a new challenge for Huimin Insurance.

From discounts for healthy people, to increased health management services, to reducing deductibles...... In order to retain more healthy groups and increase their attractiveness, new Huimin Insurance has been launched in various places.

The underlying reason behind it is that Huimin Insurance is facing the risk of a "death spiral". According to the information released by the WeChat official account of China Medical Insurance, Huimin Insurance products are essentially a model of commercial insurance, with the characteristics of selective insurance, and most Huimin Insurance products have fewer restrictions on the insured population and implement unified premium standards. In the long run, Huimin Insurance products will gradually lose the healthy groups in their insured population, and more elderly groups and groups with pre-existing conditions will join the system, which will greatly affect the sustainability of insurance participation.

Not only is it expected to break the data barrier between medical insurance and Huimin Insurance, but from the perspective of sustainable development, the draft also mentions encouraging customized medical insurance to be designed as long-term medical insurance with adjustable rates.

Combined with the current trend, long-term medical insurance not only helps to achieve more accurate risk assessment and pricing, but also cultivates consumers' awareness of long-term protection and stabilizes psychological expectations. Xu Yuchen said that Huimin Insurance is designed to be a long-term medical insurance, such as the insurance period is set to three, five or even ten years, which will help consumers stabilize their expectations. In addition, the most important thing is the rate adjustment mechanism, taking long-term medical insurance as an example, if the current year's premium is 100 yuan, if the loss ratio is higher, the corresponding risk can be resolved in the form of premium increases. Therefore, if it is designed as a long-term medical insurance, it is beneficial for both the insurance company and the consumer.

If the Draft Opinion is implemented, it means that insurance companies need to design targeted and flexible insurance products according to the protection needs of the public. Yu Fenghui, an economist and new finance expert, said that the adjustable nature of rates allows insurance companies to adjust premiums according to the actual situation and better cope with the risk of fluctuating medical costs. This provision will help promote the innovation and development of Huimin Insurance products and improve the competitiveness of the insurance market.

How to be more "standardized"

While supporting and standardizing, all localities continue to do "addition and subtraction" for Huimin Insurance. Since the beginning of this year, Hunan Province, Yunnan Province and Jiangxi Province have brewed and issued relevant opinions to guide and support the development of Huimin Insurance.

According to the Consultation Paper, insurance companies should strengthen collaboration with relevant departments to effectively identify and prevent business risks, and strengthen the management and compliance of third-party institutions that provide information technology support, specific drugs and medical devices, health management and other services.

The commercial health insurance industry and the pharmaceutical and medical device production and health management industries were originally two parallel lines. However, related enterprises with the words "technology" and "health" have become important promoters in the business chain of Huimin Insurance, and have become an important "main body" in Huimin Insurance.

For example, MediTrust Health provides operational services for Huimin Insurance's special drug services, smart underwriting, smart claims settlement, health management and other links, and Yuanxin Huibao, a subsidiary of Yuanxin Technology Group, has previously stated that it will comprehensively explore a closed loop from screening to medical, pharmaceutical and insurance services, and finally provide patients with user services throughout the life cycle.

"Third-party institutions play a key role in Huimin Insurance products. They provide insurance companies with services such as information technology support, specific drugs and medical devices, health management, etc. Regarding the necessity of strengthening the management of third-party institutions, Yu Fenghui said that it mainly includes ensuring the service quality of third-party institutions, preventing bad services from affecting the effect of insurance products, protecting consumers' privacy and information security, and preventing data leakage.

The reason why it is proposed to strengthen management and clarify the responsibilities of all parties is that for insurance companies, third-party institutions cannot be regarded as "reinsurance companies", because third-party institutions cannot "carry out the business".

It is worth mentioning that at the same level, at the level of strengthening management, conducting business in the form of group orders has become an issue that the State Administration of Financial Supervision and various dispatched agencies plan to focus on investigating and dealing with. Some industry insiders told reporters that the current business development methods similar to the form of group orders include insurance companies to a company to publicize, so that all employees can understand a certain Huimin Insurance product in a unified manner, or the subsequent collection of premiums by the enterprise and unified insurance at the insurance company. If you do not open the business through group orders, you can only sell in the form of one-to-one, which can protect consumers' right to know, and also save individuals from worrying about Huimin Baochao charges.

Beijing Business Daily reporter Hu Yongxin