Focus on the health insurance template in the great era: let commercial insurance truly integrate into the national situation

Based on the needs of the general public to reduce the burden of medical care and solve the needs of "poverty due to illness, poverty due to illness", or the demand for customized and high -quality medical services for medium and high -income people, health insurance is undoubtedly the most feel for everyone to feel the most. Obviously, the most frequent type of insurance type. Under the continuous influence of China's population aging trend and epidemic situation, the people's health awareness has been further stimulated, making the connection between health insurance and national economy and people's livelihood.

Especially since the 18th National Congress of the Communist Party of China, "healthy China" has risen into an important national strategy. In February 2020, the Party Central Committee and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", put forward "promoting the development of multi -level medical security systems", "promoting the complementary connection of various medical security", and putting commercial health insurance and social insurance Effective connection as an important measure, clarify the development direction for health insurance, and enables health insurance to usher in a period of policy opportunities; in September 2021, the General Office of the State Council issued the "Fourteenth Five -Year Plan" National Medical Security Plan to further clarify basic medical insurance The positioning of "insurance basic" encourages commercial health insurance products that connect commercial insurance institutions to develop with basic medical insurance, and better cover the cost of basic medical insurance.

The introduction of intensive policies not only shows that the party and the country's decision -making expectations for the insurance industry to participate in social governance and undertake some management functions are also an urgent need for the current reform of China's medical and health.

According to McKinsey's "Fenchen At the time: Challenge and Breakthrough of China's Commercial Health Insurance": In 2020, China's direct medical expenditure was about 4.3 trillion yuan, of which medical insurance expenditure was 2.1 trillion yuan, and personal expenditure was 2 trillion yuan, and personal expenditure was 2 trillion yuan. The compensation for commercial health insurance is only 1.2 trillion yuan, accounting for about 5%of direct medical expenditure.

In fact, whether it is from the perspective of the "country" -the proportion of total health expenses has continued to increase, or the perspective of "people" -personal medical expenditure increases year by year, and it is necessary to give full play to the compensation and participation of commercial health insurance economic insurance. The function of social management.

Looking at the Chinese insurance industry in the process of in -depth transformation reform, up to head giants, down to small and medium -sized institutions, all seek forward on the road of reform. After experienced rapid growth, the growth rate of health insurance has slowed significantly in recent years. According to the latest data from the CBRC: In the first half of 2022, the industry's health insurance premiums increased by nearly 4 percentage points year -on -year. How to find a road to say goodbye to the former model and really move towards high -quality development has become an industry consensus.

In this context, the health insurance field that carries the health and well -being of people's livelihood and is the easiest to do with social governance. At the moment when the market demand is gradually awakened, it has opened up the new imagination space of China's commercial insurance and has become the force of the industry layout.

Synchronization with the dual transformation and development of the national economy, society and insurance industry, China's commercial health insurance is also ushered in its historical key nodes: how to examine the historical position of the current health insurance? How to understand your mission and commitment to better grasp the encounters of the times?

Observing the oldest history and strongest history of the Chinese danger industry, the strongest and powerful cockpit stone giants, China Life Insurance Co., Ltd. (hereinafter referred to as "China Life Insurance Company"), after many years of deep cultivation in health insurance operations, maybe Answer this question to a certain extent.

China Life Insurance Company closely focused on the characteristics of my country's medical insurance system, deeply rooted health insurance in the implementation of the national strategy, continuously increased the supply of commercial health insurance products, supported the construction of a multi -level medical security system, and found in serving the country's overall situation. The development of the main business of insurance and the balance of social welfare. While walking out of the road with health insurance with Chinese characteristics step by step, it also gives the existing insurance theory innovation a richer connotation and extension. Essence

01

Dozens of years of deep cultivation: embedding health insurance into a multi -level medical security system

Under the social security system of the national medical insurance in my country, basic medical insurance is undoubtedly the "largest health insurance" in my country, which means that the high -quality development of health insurance must be closely carried out and extended around the national medical insurance system.

China Life Insurance Company's participation in government cooperation health insurance can be traced back to 2003. At that year, China Life and Life Insurance Company began to participate in the management of new rural cooperative medical care (referred to as "Xinnonghe") and became one of the earliest commercial insurance companies participating in the basic medical insurance business.

In 2012, the China Life and Life Insurance Company responded to the "Guiding Opinions on the Work on the Work of Urban and Rural Residents' Disease Insurance" issued by the six ministries and commissions of the State, becoming one of the first insurance companies involved in the national illness insurance system. There have been ten years. Data show that as of the end of June 2022, China Life and Life Insurance Corporation undertook more than 200 major disease insurance projects across the country, covering nearly 350 million urban and rural residents, and nearly 80%of the projects set up the responsibility for tilting the people in need. Since the state's implementation of the major illness insurance system in 2012, the company's major illness insurance has paid more than 79 million people, with a compensation amount of more than 150 billion yuan.

In 2012, Qinghai Province took the lead in launching the work of urban and rural residents' serious illness insurance nationwide. As one of the undertaking insurance companies, China Life and Life Insurance Qinghai Provincial Branch provided nearly 2.3 million urban and rural residents such as Hainan, Huangnan, Guoluo and Xining. The major illness insurance service has created an integrated service model of "basic medical insurance+medical insurance+medical assistance". In 2018, China Life and Life Insurance Jinhua Branch hosted the Jinhua Disease Insurance Project as the main contractor. The project cooperated with the local government to create and implement the nationwide "selection and payment premium law" major disease insurance that covered the whole people, unified systems, unified treatment, and policy coordinated policies. The system has realized a new model of "government guidance, public participation, and social collaboration." In addition to undertaking major illness insurance business, China Life Insurance Corporation also cooperates with government departments at all levels to carry out social insurance supplementary medical insurance business as supplements and extensions of basic medical insurance and medical insurance. Precise docking for local protection demand. As of the end of June 2022, China Life Insurance Corporation has hosted more than 170 supplementary medical insurance projects in 26 provinces (autonomous regions, municipalities), covering more than 58 million people. This includes the "great love" medical insurance project that China Life and Life Insurance Zhuhai Branch and the Zhuhai Municipal Government have jointly carried out through government -enterprise innovation cooperation since 2019. By constructing a multi -level medical security system of "basic+major diseases+additional supplements", it solves the pain points of pain points of the high amount of medical expenses caused by major diseases caused by major diseases.

With the rise of the "one city, one policy" urban customized commercial medical insurance, the rise of the "Huimin Insurance", the cooperation between China Life Insurance Company and local governments in various places will take another step. As of the end of June 2022, China Life Insurance Corporation has cumulatively landed in nearly 70 cities with customized commercial medical insurance projects in 21 provinces (autonomous regions, municipalities), with an underwriter of more than 18 million underwriters in the project. Among them, Hangzhou "West Lake Yilian Insurance" and Guangzhou "Suisui Kang" have gained a good social effect.

Perseverance and persistence, saying that it is difficult. China Life Insurance Company has always adhered to state -owned enterprises. On the basis of basic medical insurance, the insurance guarantee function of health insurance continuously and extending health insurance, actively acting and practicing internal skills, and continuously jointly build "basic+major diseases+supplements+supplements+supplements+supplements+supplements+supplements+supplements+supplements+supplements+supplements+supplements+supplements. Rescue "multiple guarantees.

02

Hundreds of new products rich in health insurance connotation, explore new fields of nursing protection

In addition to improving medical expenses reimbursement, the rapid development of health insurance also brings a broad space for innovation to the improvement of the social security system. The long -term nursing insurance that has been called for long -term appeal of all sectors of society is one of them. According to the "Chinese Pension Service Blue Book (2012-2021)", it is estimated that the total disabled population in my country will rise to 72.722 million in 2025, and will reach 100 million in 2030. With the improvement of the life expectancy and aging of the population, the survival of illness or even long -term disability and dementia will become the normalization phenomenon of some people in my country. This will not only increase the burden on the family, but also affect people's quality of life.

Establishing a long -term nursing insurance system has always attracted much attention and has been regarded as an important deployment made by responding to the aging of the population and improving the social security system. Due to the lack of experience and conditions, the development of long -term care insurance has been slow. Insurance companies involved in this field pay more attention to the design and form of products. The means of means.

In 2016, the Ministry of Human Resources and Social Affairs issued the "Guiding Opinions on the Pilot on the Pilot of Long -term Nursing Insurance System", which provided policy opportunities for the insurance industry's further exploration and development in the field. As one of the giants in the field of health insurance, the substantive connotation of Chinese Life Insurance Company deeply understands the substantive connotation of health insurance is the integration of various payment and service forms including various insurance protection and health management. Relying on the experience and resources formed by its own years of layout, China Life Life Insurance Company is committed to creating a long -term care insurance support system, and is forming the integration of "product line+service line" to provide long -term care insurance for various services, management and risk management and control of risk control and control. , Seeking innovation breakthrough. As of the end of June 2022, China Life Insurance Corporation has hosted more than 60 long -term care insurance projects in 17 provinces and cities (autonomous regions, municipalities), covering nearly 26 million people.

Among them, Chengdu project innovation and practical nursing services and grid management, create a "three real" benchmark for "real, simple, solid", formulate more than 10 full -process management specifications such as the "Guidelines for the Management of Individual Home", and establish A professional service team of more than 50 people, the proportion of medical background personnel accounts for 50%, providing a fulfilling professional support for long -term care insurance; Shandong Dongying project service covers 1.2 million participants, helping to consolidate the results of poverty alleviation and effective connection with rural revitalization. Become the characteristic of the project.

In fact, the long -term nursing insurance innovation that integrates the commercial insurance and the social security system is only one aspect of the innovation of Chinese Life Insurance Company in the field of health insurance in the past few years. In recent years, China Life has continuously increased the supply of commercial health insurance products. In terms of enriching the health insurance product system, the Chinese Life Shou Insurance Company adheres to the return of the source of the guarantee, relying on the professional business advantages of human insurance, and established a rich and diverse health insurance product system, including "national life blessings" for individual customers, "honoring the blessing of blessing blessing "Corning Insurance" and "Kangyue" series of product systems, for the major illness insurance, long -term nursing insurance, supplementary medical insurance, family planning insurance, aging insurance, small insurance, employee welfare and other product systems for government and corporate customers. From 2018 to 2021, combined with customer diversified and personalized health protection needs, more than a hundred types of health insurance products were developed. Data show that the scale of health insurance premiums in China Life Insurance Company has increased from more than 42 billion yuan in 2015 at the end of the "Twelfth Five -Year Plan" to more than 120 billion yuan in 2021, with an average annual increase of more than 19%. China Life Insurance Company has continuously improved the level of health insurance business operations and services, forming a relatively mature product development and underwriting claims risk control system, and actively builds a policy business IT platform that serves the government and medical institutions to create medical, information, and wind. The service teams of related professional background personnel such as control, intelligent and professional service levels have continued to improve.

03

The future of commercial health insurance: the transformation and development of policy and technology promotion

"Actively introduce social forces to participate in the service, and explore the establishment of a medical insurance governance pattern of co -construction and co -governance." This sentence is taken from the "Opinions on Deepening the Reform of the Medical Security System", which is not only the country's expectations for commercial health insurance, but also the test of financial insurance central enterprises China Life Insurance Company: How to help national medical insurance governance?

The answer of China Life Insurance Company is: with its own accumulation, it has given full play to the role of health insurance "connectors" and "amplifier". On the one hand, all kinds of resources are linked, and the efficiency and service experience of government projects such as medical insurance and social security in political and business cooperation will be achieved. "Co -governance sharing"; on the other hand, while improving the level of insurance protection of the people and enhancing the "sense of happiness" and "gain", gradually find the entry into the port of business value, so that people can truly see that business and social and people's livelihood are positive. The possibility of cycle.

During this process, China Life and Life Insurance Company accumulated a lot of valuable "co -construction and governance" experience in the medical security. , Accidental medical care, employee supplement, fund supervision and many other types of health guarantee entrusted management services, and have created a number of typical models in Henan, Jiangsu, Guangdong, Guizhou and other provinces. As of the end of June 2022, China Life Insurance Company continued to host more than 300 health guarantee commissioned management projects, with more than 100 million service groups.

In addition, China Life and Life Insurance Corporation is still building a health service system with the characteristics of Chinese life and covering a full life cycle under the Group's "Great Health" strategic framework and strong technological investment. According to reports, as of the end of June 2022, the "National Life Big Health" platform has been connected to provide more than 100 health service projects, providing diversified health services for individuals and group customers of China Life, and continuously exploring the "insurance guarantee+health service" model Innovation.

In recent years, in order to actively respond to the reform of national medical insurance payment methods, China Life Insurance Company has actively jointly jointly cooperated with relevant medical insurance technology companies to participate in the reform of national DIP and DRG in Yingkou, Shaanxi Hancheng, Heilongjiang Jiamusi, Sichuan Meishan and other places. And achieve preliminary results. The "four -in -one" medical risk management and control system for "intelligent review+institutional inspection+case survey+expert meeting" has been established to effectively help improve the supervision level and effectiveness of medical insurance funds.

The above not only reflect the professional capabilities of the health insurance operation of Chinese Life Insurance Company, but also to a certain extent to a certain extent the higher level of social governance efficiency.

From the traditional "single payment party" to "full process management service", from "insurance protection" to "social management", under the "health China" strategy, China Life Insurance Company continues to deepen its practical cognition: Health保险应从纯粹的保险保障、保险金给付，向提供健康管理、参与社会管理转变，在与医保等社会保障深度绑定的基础上，真正实现商业保险对社会治理的深度参与，找到商业健康保险与The maximum balance point of social interests.

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