| As of February 2019,there were seven professional health insurance companies in China.In 2018,the total original insurance premium income of seven professional health insurance companies in China was 21.568 billion yuan,and their main business was commercial health insurance.In 2018,the total original insurance premium income of the commercial health insurance in China reached 548.813 billion yuan.It can be seen from this that the health insurance business of professional health insurance companies in China occupies a small market share in the commercial health insurance market.Compared with other types of commercial health insurance business entities,China’s professional health insurance companies are not competitive in the market,and the advantages of specialized management are not well reflected.As a core enterprise of the health insurance industry chain,China’s professional health insurance company has insufficient decision-making control on other node enterprises in the health insurance industry chain,and has problems such as high loss ratio and weak risk management and control.This is the bottleneck restricting the professional development of China’s professional health insurance companies.Based on this,China’s professional health insurance companies need to integrate their own health insurance industry chain,strengthen decision-making control of industrial chain node enterprises,thereby improving professional management capabilities and market competitiveness.Medical service providers and health service providers are the two most important parties in the integration of health insurance industry chain for China’s professional health insurance companies.Whether the two parties can be effectively integrated is the key to the success or failure of the integration of health insurance industry chain for China’s professional health insurance companies.In recent years,China has successively issued the "Healthy China 2030" Planning Outline,the "13th Five-Year Plan for Deepening the Medical and Health System Reform",and the "Opinions of the General Office of the State Council on Supporting Social Forces to Provide Multi-level Diversified Medical Services".The documents clearly indicate that the state supports insurance companies to establish deeper cooperative relations with medical service providers and health service providers,and objectively provides policy support for China’s professional health insurance companies to integrate the health insurance industry chain.Through the use of relevant theories of industrial chain integration,and drawing on relevant foreign advanced experience,the author has carried out a detailed analysis of the dynamics,environment and integration path of the health insurance industry chain integration of China’s professional health insurance companies,and finally the specific integrated design scheme is put forward according to the actual situation of the professional health insurance companies in China.This article consists of six chapters.The main contents and opinions of each chapter are as follows:The first chapter is "Introduction".Firstly,this chapter elaborates the background and significance of the integration of health insurance industry chain in China’s professional health insurance companies.Then it systematically combs the domestic and foreign literature on commercial health insurance,professional health insurance companies,health insurance industry chain and related content,and reviews the current research situation.Furthermore,the research ideas and methods of this paper are put forward.Finally,the innovation and shortcomings of this paper are briefly explained.The second chapter is the definition of basic concepts.The first section of this chapter defines the concepts of commercial health insurance and professional health insurance companies.The second section of this chapter defines the concept of industry chain,health insurance industry chain and health insurance industry chain integration,and summarizes the important attributes of the health insurance industry chain.The third chapter expounds the status quo of China’s professional health insurance companies and their health insurance industry chain.The first section of this chapter introduces the current situation of China’s professional health insurance companies.It comprehensively elaborates on the overall situation,market competition status,insurance structure and risk management and control capabilities and profitability of professional health insurance companies,and points out the problems.The second section of this chapter examines the development status of the health insurance industry chain of China’s professional health insurance companies from the perspective of the industrial chain.Specifically,on the one hand,the development status of health insurance industry chain of China’s professional health insurance companies is examined from the integrity of the health insurance industry chain.On the other hand,by examining the cooperation mechanism between professional health insurance companies and various node enterprises in the health insurance industry chain,the development status of the health insurance industry chain of China’s professional health insurance companies is clarified,and the problems arising from them are pointed out.The fourth chapter is the motivation and environmental analysis of the integration of health insurance industry chain by professional health insurance companies in China.The first part of this chapter makes an in-depth analysis of the motivation of China’s professional health insurance companies to integrate health insurance industry chain through the three traditional theories of industrial chain integration.China’s professional health insurance companies carry out the integration of health insurance industry chain,which can enhance the market power of professional health insurance companies from the perspective of industrial organization theory;from the perspective of transaction cost theory,it can reduce the transaction costs between professional health insurance companies and various node enterprises.From the perspective of enterprise capability theory,it can enhance the ability of China’s professional health insurance companies to allocate and integrate resources and capabilities in the entire health insurance industry chain,thereby enhancing their market competitiveness.In the second part of this chapter,on the basis of proving the importance of the integration of health insurance industry chain by professional health insurance companies in China,the internal and external environment of the integration is comprehensively analyzed.From the internal environment and the external environment,the paper analyzes the internal advantages,internal disadvantages,external opportunities and external threats of the health insurance industry chain integration of professional health insurance companies in China.Based on the environmental analysis,the countermeasures are briefly proposed.The fifth chapter analyzes the integration path that Chinese professional health insurance companies should choose when integrating the various nodes of the health insurance industry chain.The first section of this chapter analyzes the integration path that Chinese professional health insurance companies should choose in integrating medical service providers.The specific integration targets include medical institutions,Internet medical platforms,and drug suppliers.This part firstly analyses the characteristics of medical service providers,points out which integration paths should be chosen by professional health insurance companies when integrating medical institutions,internet medical platforms and drug suppliers,and expounds the advantages and disadvantages of various integration paths.Then,by analyzing the specific cases of other insurance companies integrating medical service providers,in order to obtain relevant experience for reference.Finally,the paper puts forward the strategies that the professional health insurance companies should adopt to integrate the medical service providers.The second section of this chapter analyzes the integration path that Chinese professional health insurance companies should choose in integrating health service providers.The first is to analyze the characteristics of health service providers,and put forward the advantages and disadvantages of the various integration paths that Chinese professional health insurance companies choose when integrating health service providers.Then,by analyzing the cases of other insurance companies integrating health service providers,they can learn from experience.Finally,on the basis of summarizing the contents of this section,it puts forward the strategies that should be adopted by professional health insurance companies in integrating health service providers.The third section of this chapter briefly analyzes the integration path that Chinese professional health insurance companies should choose in integrating their competitors.The sixth chapter is to propose the specific scheme design of China’s professional health insurance company to integrate the health insurance industry chain.The whole design scheme is divided into three parts.The first part is to determine the goals of the health insurance industry chain integration and the basic principles to be followed.The second part is to determine the choice of integration objects and the integration path based on the summary of the full text.The third part proposes to ensure the stable operation of the health insurance industry chain by constructing an unobstructed communication and coordination mechanism,a reasonable benefit distribution mechanism,and a sound supervision and incentive mechanism.The innovations and shortcomings of this paper are as follows:There are two innovations in this article.First,it provides a new research perspective for the study of the development of professional health insurance companies in China.At present,there are few studies on the development of professional health insurance companies using industry chain theory at home and abroad,and most of them are based on the analysis of the industrial chain extension perspective.There is almost no research on the development of China’s professional health insurance companies from the perspective of industrial chain integration.This paper innovatively analyzes the problems encountered by professional health insurance companies in China through the thinking framework of industrial chain integration,which not only makes the analysis more in-depth,scientific,but also provides a new research perspective for the study of the development of China’s health insurance companies.Second,this paper summarizes two important attributes of the health insurance industry chain,that is,the end of the health insurance industry chain breaks through the pattern of the industry chain that generally ends with consumers and the health insurance industry chain is an industrial chain based on functional division of labor.This has a important influence on analyzing the structure of the health insurance industry chain and exploring the motivation and path of the insurance company to integrate the health insurance industry chain.The shortcoming of this paper is that because China’s professional health insurance company was established late and its strength is weak,there is a lack of practical experience and relevant data in the integration of health insurance industry chain,which makes it impossible to conduct quantitative analysis. |
