Research On The Development Of Managed Oral Medical Insurance In China

Oral health as a mirror of people’s health is closely related to the occurrence of other diseases in the whole body.With the development of economy and the improvement of personal income,people begin to realize the importance of oral prevention and control.More and more people have the demand of oral treatment,and also face the economic burden brought by oral disease treatment.However,the basic medical insurance covers very limited oral disease treatment projects,and the general commercial oral health insurance can only play a preventive and health care role,and can not meet the multi-level needs of people’s oral medical projects.In this context,the management oral health insurance came into being.As an innovative product combining management medical model with commercial oral medical insurance in China,Taikang Baibo oral cavity reduces the medical expenses of the insured and enjoys more oral medical services,and at the same time,it also makes the insurance company and medical institutions share the same solidarity,and truly realizes the purpose of controlling the expenses and reducing the compensation rate.Management oral health insurance plays an important role in helping to promote the healthy development of the oral health industry in China.Therefore,it is of great theoretical and practical significance to study the management oral health insurance.In 2018,Taikang online Property Insurance Co.,Ltd.and Taikang Baibo stomatology Co.,Ltd.launched the "Taixin e-tooth health" product,which is another exploration of the managed oral medical insurance product and a vivid portrayal of the health maintenance organization(HMO)model.This paper analyzes the application of HMO model in commercial oral medical insurance and the setting of TKD,discusses its advantages and innovations in detail,and then studies the development countermeasures of managed oral medical insurance products in China.Among them,HMO model mainly refers to the American health maintenance organization,which is one of the most representative models in managed care.In the early stage,HMO usually refers to own hospitals or employ doctors,and then further extends to signing contracts with multiple hospitals,medical associations or individual doctors.After paying a certain fee,members can enjoy a variety of medical services,including preventive health care,free of charge or at a lower price in the network of medical institutions signed by HMO,so as to avoid excessive out of pocket expenses.TKD(Taikang dental operation system)system is an organic combination of Taikang Insurance Group and Taikang Baibo oral operation service after in-depth research on the operation and management mode of oral industry.It operates as Taikang oral international standard operation system.This paper is divided into six parts.The first part introduces the case of "taixinxiang e-dental health" jointly launched by Taikang online and Taikang Baibo Stomatology,and leads to the research object of managed oral medical insurance.In the second part,the author makes an in-depth analysis of the above cases to explore the advantages and innovations of this product,as well as the significance of this product in China’s insurance industry.This paper analyzes the feasibility and necessity of developing managed oral medical insurance in China to see if it has the significance and possibility of development in China.The third part studies the development status and existing problems of managed oral health insurance in China,and analyzes from three aspects: products,coverage rate and the distribution of medical treatment points.It is concluded that there are many commercial oral health insurance products,insufficient managed oral health insurance products,and young people in economically developed areas have strong purchasing consciousness,but there are product defects,low coverage rate,low cost,and so on The problem of uneven distribution of designated clinics.In the fourth part,the factors influencing the development of managed oral health insurance in China are analyzed in detail.The results show that the development of managed oral health insurance in China is restricted by five factors: imperfect policies and regulations,weak awareness of national oral health care,insufficient publicity,lack of oral health service resources and uneven regional distribution,and lack of innovation power of insurance companies.The fifth part introduces the history,current situation,products and providers of managed oral health insurance in the United States,from which we can draw lessons.The sixth part,aiming at the problems existing in the development process,and drawing lessons from foreign experience,puts forward the following countermeasures and suggestions: improve the laws and regulations of the oral industry,give play to the government’s guiding role,including improving the laws and regulations of the oral industry and strengthening supervision,introducing the relevant oral medical insurance system by the Insurance Association,and giving play to the government’s supporting policies and guiding role;To improve the ability of product innovation and channel development of insurance companies,we should extend the waiting period,reduce the occurrence of adverse selection,design hierarchical products,and cooperate with more medical institutions;To promote the rational allocation of oral medical resources and improve the public awareness of oral health care,including the development of oral related industries and the rational allocation of oral medical resources,and the promotion and education of oral health.