focus on the two sessions| National People’s Congress Representative Zhou Yanfang: Encourage the misaligned development of commercial insurance and basic medical insurance, and suggest vigorously promote one-stop settlement of commercial insurance in public hospitals

(Photo source: Visual China)

Blue Whale News, March 4 (Reporter Shi Yu)Commercial health insurance is an important part of the 1+3+N multi-level medical security system. According to 2023 health data, my country’s direct medical and health expenditure growth rate will reach 11%, and the proportion of personal medical and health expenditure still stands at a high level of 43.6%. As China’s population aging accelerates and medical and health expenses increase, residents ‘medical and health needs will continue to increase, and medical insurance funds will face greater pressure. Vigorously developing commercial health insurance and increasing the scale of commercial insurance financing have become the consensus and top priority of the whole society.

Blue Whale News reporter learned that during the two sessions this year, Zhou Yanfang, a representative of the National People’s Congress and director of the Strategic Research Center of China Pacific Insurance (ESG Office), put forward a number of suggestions, including suggestions on supporting and guiding the accelerated development of commercial health insurance. She told reporters that the development of commercial health insurance will help alleviate the operating pressure of medical insurance funds, reduce the burden of medical expenses for individual residents, support medical institutions to provide high-quality personalized medical services, and promote the healthy development of the biomedical industry.

Zhou Yanfang, Representative of the National People’s Congress and Director of the Strategic Research Center of China Pacific Insurance (ESG Office)

However, the current development of commercial health insurance has difficulties such as unclear positioning, weak sense of acquisition, and insufficient innovation in products and services. It is necessary to further support it from the policy level to promote commercial health insurance to play a role in reducing personal medical burdens and supporting the development of the biomedical industry. Greater role.

In terms of specific suggestions, Zhou Yanfang first proposed thatIt is recommended to clarify the important pillar role of commercial health insurance in the multi-level security system.Clarify the third-level protection status of commercial health insurance in the multi-level security system, clarify its important supplementary role in basic medical insurance, and propose to include relevant requirements in the Medical Security Law. Encourage the misaligned development of commercial insurance and basic medical insurance. Commercial insurance products should focus on self-paid medical expenses to form a complementary connection with basic medical insurance, and leave room for commercial insurance self-paid medical expenses in the reform of medical insurance payment methods.

Second, it is recommended to vigorously promote one-stop settlement of commercial insurance in public hospitals to improve medical institutions ‘awareness of commercial insurance payments.It is recommended to refer to Shanghai, where local governments should take the lead in building a direct compensation platform for medical insurance commercial insurance. Commercial insurance institutions will directly allocate compensation to hospitals, which not only effectively relieves the pressure on individuals and hospitals to advance medical expenses, but also allows hospitals to see more clearly the role of commercial insurance as a payer and improves the claim settlement experience of commercial insurance customers. At the same time, we will continue to expand the scope of direct compensation medical institutions, enrich the types of direct compensation products, and increase the utilization rate of commercial insurance direct compensation services.

“It is recommended to further give full play to the guiding role of tax incentives and medical insurance individual account policies,Zhou Yanfang proposed that the first is to increase the publicity of commercial health insurance tax preferential policies. Referring to Shanghai, the government can clarify the operating method for enterprises to purchase short-term group commercial health insurance for all employees and include 5% corporate income tax before tax, so as to improve policy awareness, and the enthusiasm of enterprises to purchase commercial health insurance for employees. The second is to improve the convenience of purchasing commercial health insurance from individual medical insurance accounts. Further increase the publicity of individual medical insurance accounts to purchase commercial health insurance. Both government public platforms and official platforms of insurance companies can open insurance entrances, and further clarify the access standards for individual medical insurance account products, speed up approval, and enrich product selection space. rdquo;

At the same time, it is recommended to support the development of corporate health insurance and mid-to-high-end medical care.In my country, commercial health insurance is mainly purchased by individuals. The development of corporate employee welfare insurance is relatively slow and there is large room for growth. It is recommended to further encourage enterprises to purchase commercial health insurance for employees to meet the higher demand for high-quality medical care of middle and high-income people and better retain talents for enterprises. At the same time, it is recommended to encourage hospitals for special needs and international medical departments to provide differentiated services for commercial health insurance, effectively support the differentiated product positioning of commercial insurance mid-to-high-end health insurance, and enhance the claims settlement experience of commercial insurance customers through system docking and one-stop settlement.

In addition, Zhou Yanfang also proposed thatIt is recommended to provide medical insurance medical data support for the development of commercial health insurance products.Understanding the incidence of diseases by regions, age groups, and various diseases, as well as the cost of treating these diseases, is the basis for the pricing of health insurance products of commercial insurance companies. ldquo; It is recommended to further promote data sharing between medical insurance, medical care and commercial insurance for more accurate product pricing and risk management. At the same time, medical, pharmaceutical institutions and commercial insurance companies are encouraged to establish risk sharing and benefit sharing mechanisms to jointly promote the development of innovative commercial health insurance products. rdquo;