Regulation And Development Research On Chinese Commercial Health Insurance

The Commercial Health Insurance of China started in the early 1980s, the restoring time of the life insurance business. Till the end of 2006, there are more than 40 life insurance companies and 30 property insurance companies started the Commercial Health Insurance operations. And such like PICC health insurance and Pingan health insurance, 4 professional health insurance companies started their operations, the kind of the health insurance products also reached 300. Recently , each insurance companies have had a better understanding of the characters about the health insurance operations, the operations are developing fast and the incomes are increasing very fast, the average of each year is 30% ; the structure of the main operation is changing form group business to personal business. Besides, comparing with the status of health insurance developing in the developed countries, the health insurance market in our country has a high potential, the society service function of the Commercial Health Insurance is far beyond its expectations in the national health system. On the other side, because the professional management of our country's health insurance is still in the elementary stage, the inspecting and criterion of the health insurance business haven't formed a system, and the related rules are not perfect. There are still many questions to be discussed. Here we mainly discuss the problem of regulation and development of the Commercial Health Insurance, trying to perfect the regulation and development of the Commercial Health Insurance and other related rules, exploring a suitable way of the health insurance developing for our country.From the definition the regulation, the narrow sense of regulation only means the government supervises and manages the institutions of insurance; in the broad sense, besides the narrow sense of regulation, also including the criterion of the insurance market, namely the industry self-discipline and the internal control of the insurance companies itself. In this article the"Regulation"mainly chooses the narrow sense definition. From the contents of the regulation to the finance intuitions in the world, the regulation to the Commercial Health Insurance should be divided into the following aspects: the regulation to the admittance of the market, the regulation to the actuarial and financial regulation, the requests of the management, the regulation to the contract and the regulation to the reinsurance.The author believed that: to compose the system of regulation and criterion of the Commercial Health Insurance integrated, we should not only focus on the government supervision in the narrow sense, go deep into the research on the lack of the regulation, but also should attach importance to the self-discipline of the industry, and important function of the operation internal control to the health insurance developing. If we can solve the existing problems of the regulation and the criterion of our country's Commercial Health Insurance, not only it will have a magnitude meaning about the health insurance of our country, but also will have a great impact on the national health system. The author mainly reviewed status of the regulation and criterion about our country's Commercial Health Insurance from three different angles: government, industry and company, analyzed the existing problems deeply, and on the basis of taking the experience of some developed countries and areas used for reference, linking with the situation of our country, gave some material suggestions to perfect the regulations and criterions of our country's Commercial Health Insurance in the way of giving examples.The main content and structure are organized as follows:The first chapter mainly expatiates the research background, meaning, content, method of the dissertation, and have a completely and systematic review of the related literatures about Commercial Health Insurance regulation and development. This dissertation conclude the basic situations of the Commercial Health Insurance regulation and development of our country from the aspects of Commercial Health Insurance admission of marketing, actuarial and financial regulation and the operations of health insurance, points out the problems of the health insurance market still remains and more strengthen and perfecting of the regulation and criterion is needed. Further more , through the reviewing and conclusion of the literature, the author thinks that the research about the Commercial Health Insurance regulation and development from the angle government ,industry and company entirely is still blank in our country. So, learn from the theories and methods from abroad and combining with the problems in our country to analysis from examples is the main research method in this dissertation.The second chapter discusses the related problems of our country's government supervision on the Commercial Health Insurance. First, definitude the duty of the government in the Commercial Health Insurance'regulation, consider its duty should contain policy establishment, cooperation, regulation and establish the related laws. Second, points out that our country's government supervision on the Commercial Health Insurance should have some improvements and perfections on the aspects of admission and quite of the market, actuarial regulation, the related rules, finance and behaviors about the contract articles. On that basis, the author take the published by the industry association, and gave some suggestions about it on the basis of the foreign experiences and the situation of our country. Besides that, the insurance industry association should continue their work on the basis of the formalization of the health insurance products'contract clauses, motivate the edition of the morbidity table, vigorously develop the training and education of the professionals and increase the promoting to help the industry to develop.The fourth chapter mainly discusses the related problems about the internal control about the of the Commercial Health Insurance industry. The internal control of the health insurance is a series of control methods to modulates, communicates and restricts the health insurance business management and the activities of the insurance company to assure its management does not departure from its goals. Government restriction and industry self-restriction are both the outer-force of the health insurance restriction and criterion, and the internal control is a self-restriction activity, it has an important mean on the criterions of the management, the preventing of the risks, the increase the stuff of the employees and the motivating of the operations of the health insurance. Here we analyzed the lack of the internal control of the insurance companies'insurance operations, and the author points out that the internal control of the business health insurance should takes its emphases on the construction of the information system and database ,the construction of the system of underwriting and claim and the risk control of the medical service suppliers. At last, in allusion to the key problems of the internal control of the health insurances, the author brings forward the exact methods to perfecting the internal control system.The main point of view and contribution of this dissertation:(1)It's the first time to analyze the health insurance regulation and development problems for the angles of government supervision, industry self-discipline and company internal control. The author figured that the regulation and criterion of the health insurance should not only depends on the hard working and perfecting of the policies and criterions by the government and regulation department, but also needs the industry association to fulfill their power of self-discipline. And the same time the insurance company itself needs to highly attach importance to the internal control problems of the health insurance businesses. No more than the foundation of the macro, normal and micro three-in-one regulation system, the continuous development of the commercial insurance could be guaranteed. (2) On the problems of the Commercial Health Insurance government supervision, the author gives some suggestions about the < health insurance management ways> from the aspects of premium regulation, reserve regulation and the contract clauses for the first time. (3) On the aspect of the industry self-discipline of the Commercial Health Insurance, the author gives some modification suggestions to the from the aspects of the disease treatment methods, the popularization of the clauses, adding the special clause explanations and restrictions, and suggests the industry association to constitute the projects of the edition. (4) On the internal control of the health insurance business, aiming at the key problems the author gives the exact solutions; it has a great meaning on the internal control system of the health insurance business.This dissertation only expatiate the content from three aspects, neither discuss the regulation of the commercial health insurance and development on the height of the national health policy nor taking the consideration of the fact of the country's commercial health insurance development to have a deeper research on the problems of correct the market failure from the angle of health economics. Because of the novelty of the subject and argumentation, the shortage of time, and the limited ability of the author, there are still some disadvantages and mistakes in the dissertation.