Tpa Model Case Study In China Health Insurance

With the rapid development of China's economy and society,commercial health insurance has gradually become an essential part of medical insurance,and the demand for commercial health insurance is increasing.However,in reality,many insurance companies in our country are less profitable in the health insurance business,and some companies even have a loss.The main reason for this phenomenon is the development of the market is not standardized,high loss rate,lack of professional ability and information asymmetry in the payment process.With China's new health care reform plan surfaced,separate management,government procurement of services will be one of the direction of the reform of medical insurance system.In 2009,the CPC Central Committee,the State Council promulgated the "on deepening reform of Medical System Reform Opinions" clearly pointed out: "actively advocated the purchase of medical insurance services,entrusted with the exploration of the commercial health insurance agencies to provide various medical security management services";"new medical reform" pointed out the direction for the development of commercial health insurance in China,we can learn from the successful experience of developed countries in health insurance,the third party health care management,TPA mode.Third party health management is an innovative model,is independent of the insurance companies and the medical service institutio ns of the third party,it can alleviate the problem of information asymmetry,cost control claims in commercial health insurance and improve medical service to a certain extent.At present,the management of medical insurance third party in China is still at the exploratory stage in our country,so with the development of the third party medical management,many problems have appeared,mainly reflected in the legal supervision system is not perfect,blind experience abroad,the status of public hospital,strong awareness of the third Party health care management is not sufficient etc..In this regard,how to effectively improve these problems is crucial to the development of TPA in china.This paper first introduces the background and significance,combined with China's commercial health insurance market to introduce the TPA mode,TPA mode analysis of current development in our country,secondly,through the case of our local business Baotong company "combined with the lack of commercial health insurance in China,analysis of the third party health management of China's health insurance development play a role;then a combination of these cases to analyze current problems in the development of TPA supervision,lack of knowledge and experience.Finally,combining the successful experience of the developed countries of foreign TPA with the market environment and background of our country,summing up the experience,and putting forward the effective solutions to promote the development of TPA in our country.