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Commercial health insurance gets boost

Updated: Nov 18,2014 8:33 PM

The State Council issued a circular on Nov 17 asking all provincial-level administrative divisions and ministerial-level departments under the State Council to speed up the development of commercial health insurance.

The circular said that commercial health insurance, offered by commercial insurance companies, includes programs such as disability income, long-term care and medical liability — and complements basic health insurance programs by covering health expenses not covered by basic programs.

The State Council aims to set up a modern commercial health insurance industry with a market mechanism and various types of products by 2020.

It also aims to improve the operation of the insurance industry and the quality of its service to significantly increase the number of people choosing the insurance and the amount of health expenses reimbursed.

The circular also said that authorities should take the lead in developing commercial health insurance while letting the market play a decisive role.

The authorities should implement better regulations and policies, enhance market supervision, and guide the market through tax and industrial policies to help the latter play a decisive role in distributing resources. The authorities should also encourage commercial insurance companies to improve the quality and efficiency of their service.

Additionally, the circular said that commercial health insurance should deepen reform and promote innovation of its service and management, thus helping other industries — such as healthcare and healthcare management — to develop.

According to the circular, the authorities should make great efforts to develop commercial health insurance programs that cover health expenses not covered by basic health insurance, and encourage enterprises and individuals to purchase commercial health insurance and various other insurance programs to meet their requirements.

The authorities should encourage commercial insurance companies to develop health risk assessment and intervention programs to lower health risks and prevent diseases.

The authorities are required to encourage commercial insurance companies to develop insurance programs to cover high-end medical services and also develop insurance programs covering adverse drug reaction.

Additionally, the authorities should assist the development of disability income insurance to compensate for the loss of income of employees suffering from diseases or injuries.

They are also required to encourage the use of long-term care insurance offered by commercial insurance companies, and other commercial insurance programs, to meet the needs of the elderly. Insurance programs reimbursing the cost of traditional Chinese medicine services are also to be encouraged.

The authorities should speed up the pace of development of medical liability insurance and explore various types of insurance programs to help solve disputes between health service providers and their patients, guarantee legal rights for both health service providers and patients, and help improve relations between providers and patients.

The authorities should encourage healthcare institutions and doctors to buy malpractice insurance, and make sure that it is valid if a doctor moves to a different location to practice medicine.

The State Council also required authorities to encourage commercial insurance companies to play a bigger role in improving the country’s health insurance system.

And local authorities around the country should set aside funds from two public health insurance programs to set up special insurance programs to reduce the financial burden of serious diseases. The insurance programs covering serious diseases are encouraged to be offered by commercial insurance companies.

The authorities should also encourage reputable commercial insurance companies to offer various kinds of insurance programs, so as to lower the costs of running the programs, and increase management efficiency and the quality of service.

Hospitals are encouraged to take out commercial health insurance programs, as the companies offering the programs will encourage hospitals to lower unreasonable medical costs and medical risks by adjusting the rate of reimbursement based on the hospital’s performance.

The State Council said in the circular that, in order to improve the quality of commercial health insurance services, commercial insurance companies should establish independent revenue and expenditures accounting.

The authorities should also establish a system to record commercial insurance agencies’ credit information.

Commercial insurance companies should nurture competent employees with professional skills, and the companies should do their best to offer convenient and quality services.

Commercial insurance companies are encouraged to take part in building public health databases.

Information systems of commercial health insurance programs should be able to share data with the information systems of basic health insurance programs and hospitals.

However, the authorities and commercial insurance companies must protect personal information of insurance consumers, and prevent data leakage and abuse.

Various government departments should work together to strengthen supervision of commercial insurance companies and ensure reasonable and orderly competition. The companies should cooperate with the official departments when the latter are conducting inspections or investigations concerning their activities.

The official departments should also impose severe penalties for illegal behavior of the companies, such as misleading consumers and leaking personal information or insurance fund information of the insured.