The Horn of the insurance industry in the medical establishment is officially sounded

Recently, China Insurance Regulatory Commission on its official website published on the implementation of the "Twelve-Five" period of deepening the reform of the medical and health system planning and implementation of the notice (hereinafter referred to as "notice"), the demand for insurance services reform, vigorously develop commercial health insurance and encourage exploration insurance companies to set up medical institutions.

As for the specific policies to encourage the development of health insurance in the future, the CIRC said that it would improve the health insurance industry development policy according to the "Twelve-Five" planning requirements of the medical reform, and formulate relevant preferential policies such as taxation, to encourage enterprises and individuals to participate in commercial health insurance and various forms of supplementary insurance.

Covet the acquisition of a hospital

The notice requires that each insurance company should strengthen the construction of health insurance information System, carry out data accumulation and analysis conscientiously, improve the management and control ability of health insurance risk, explore the feasibility and effective ways of establishing medical institutions and participating in restructuring and reorganization of public hospitals, and extend the chain of health insurance industry.

And at this point, China's peace is again at the forefront. Ping An has held at least two hospitals, Shunde Peace Hospital and Shenzhen Longgang Hospital, with more than 40% per cent stake in Ping An, and its chairman has been appointed by senior Peace Trust executives, according to people familiar with the matter.

The coveted hospital is not just a safe house. The above people said, the harmonious health insurance is currently negotiating the acquisition of Shenzhen Dragon Pearl Hospital Hundred shares, is expected to spend 500 million yuan, "there is a hospital in Shijiazhuang, now as long as there is a hospital to sell, harmonious health are talking." ”

Insurance companies in the investment hospital favored by the reason, not only optimistic about the hospital Chaoyang industry's profit prospects, but also want to promote their own insurance sales, training health insurance personnel.

According to investment promotion of health insurance marketing vice President Zhou Yue, 2011 China's commercial health insurance premium income of 69.17 billion yuan, the total personal insurance premiums of 7.1%, far below the current foreign mature market ratio.

From the Global Business health insurance development model, often experienced from the basic products to mature products to innovative products three stages. China is still in the first stage to the second phase of the transition period, the market is still dominated by major diseases, hospitalization allowances, and social security links to the group fee compensation type of basic products, Zhou Yi said.

Pilot real-time settlement

Two or three months later, the insurance company's commercial health insurance will be expected to achieve the same as social security network real-time settlement. In other words, customers do not need to advance medical costs, the cost will be expected to be realized by the hospital and the insurance company directly settlement. Nanjing and Xiamen will be the first pilot cities. A person involved in the pilot work said.

Six months ago, Xiamen and Nanjing, the OCI is already in coordination with the local Health bureau and Social Security agencies, the person continued, the National Insurance Standardization Technical Committee entrusted to peace, Chou, PICC and Taiping prepared the "Health care data exchange norms", has been the industry level of support.

In fact, before the decision was made to unify the pilot network in the whole industry, the companies such as China Life and Taikang had already tried to push the net settlement in individual districts. If Taikang has contracted a network settlement hospital more than 200, but each company's standards and data requirements are not the same, can not be widely promoted. And the goal of this pilot is to achieve a unified industry-wide standardization of data networking.

At present, commercial health insurance claims are still based on paper bills, treatment after the end of the customer to the insurance company claims, resulting in claims processing costs are high, efficiency is slow. Since the insurance company received the claim, need to paste-scan-input-adjustment-audit and other process processing, and the domestic and hospital medical document format and content are not unified, resulting in low manual input efficiency, while requiring the claim adjuster must master medical knowledge, so that health insurance claims costs very high.

Research data of an insurance company show that the cost of a hospitalization insurance case is about 80-100 yuan. Claims time is also slower, generally in the daily calculation.

"At present, the first step is to query the customer's health information, the second step is data transmission, the third step is real-time transmission, network settlement." "said that the realization of network settlement, claims can be automatically completed, the efficiency is very high, can be" day "era into the" second "era. At the end of a client's visit, you can complete the claim procedure at the hospital.

Not only that, a life insurance company claims department head said, previously only after treatment to start the claims process, insurance companies can not in the treatment and treatment process of risk management, passive pay. With the interconnection of hospitals, insurance companies will have the opportunity to prevent unreasonable treatment before the end of the treatment and to control the risk more favourably.

After networking, insurance companies can also provide low-cost and convenient access to customer clinical treatment data, through data mining and collation, so that products pricing more scientific, and constantly improve medical payment technology and methods, such as paying for medical quality, incentive medical institutions to reduce the cost of medical care, providing better treatment.