Research On Developmental Stratagem Of Business Health Insurance On The New Healthcare Reform

In April2009the CPC Central Committee and the State Council issued the “Opinionson Deepening the Reform of the Healthcare System” and the new health-care reformprogram was put into practice. According to the objectives of the reform, by2020a basichealthcare system that covers all urban and rural residents is to be established (including apublic health service system, a medical service system, a medical security system and a drugsupply system), and thus comprehensive access to basic health services is to be achieved. Interms of medical security, in addition10insisting on creating and improving the basic healthcare assurances, the new health-care reform program also states that “the commercial healthinsurance should be actively developed”.In1990’s, the beginning of the reform of Chinese medical insurance system for urbanworkers has created a good space for China’s commercial health insurance development. Ourcountry’s productivity decide that the existing social health insurance has a low, limited level,so we have to develop the commercial health insurance to build a multi-level medicalsecurity system.Based on the financing mechanism of the medical system, the theory of informationasymmetry, and the theory of public choice, this paper argues that the commercial healthinsurance and social health insurance should have a coordinated development Whenconstructing the new health security system，build a new health security model in which thecommercial health insurance and the social health insurance complement and cooperate witheach other and develop jointly. Beyond the basic medical needs, the market mechanismshould play a greater role through flexible commercial health insurance.To this end, onemust redefine the position of the commercial health insurance in the health security systemso that it is not only a limited and simplistic supplement to the basic social health insurance,but also an essential and indispensible component in China’s health security system.This paper discusses the role of the commercial insurance in the healthcare system byexamining the evolution of the healthcare systems in many countries. The commercial healthinsurance can be put into four categories: basic type, repeated type, cost-supplement typeand item-supplement type. Different forms of commercial health insurance match with healthcare systems of different kinds. International experience shows that the sounddevelopment of the commercial health insurance requires maintaining an appropriate level ofcompetition under regulation.At present, China has established a preliminary multi-level health security system withthe major component being the basic security system. The commercial health insurance isnot just playing the role of supplementing the basic medical insurance by providingadditional medical insurance products, but it also gets involved in the management of thebasic healthcare through funds management, insurance contracts, hybrid model, and othermeans. However, the path of development for the commercial health insurance is not smooth.In the current Chinese environment, the commercial health insurance faces three majordifficulties: the policy dilemma, the market predicament and the plight of the industry. Thesedifficulties arise mainly from the deep-seated reasons in five areas: ambiguous policyorientation, the pursuit of profit by commercial health insurance, the infant nature of thecommercial health insurance in China, the decentralized management system, and thefee-for-service payment model for medical services.Because of these problems, the paper outlines three stages of development for theChinese commercial health insurance industry based on the objectives of China’s healthcarereform. It includes three most important strategies for development of the commercial healthinsurance: the better external environment strategy; the risk management strategy; theoperation model strategy.