A Study On Legal Issues Of “Designated Hospital” Medical Insurance Under The Equity Investment Mode

With the deepening of the reform of medical system in China and the introduction of Certain Opinions of the State Council on Accelerating the Development of the Modern Insurance Service Industry on August 13,2014,insurance companies are allowed to set up medical institutions and participate in the reform of public hospitals by “equity investment” and “ strategic cooperation.” In order to implement the policy in a better way regarding the protection mechanism of medical insurance consumers,this paper,through legal researches and reality investigation,will discuss the existing mode of designated hospitals of insurance companies and its major problems,and focuses on the possible changes and benefits of the current mode in the case of insurance companies' investment in medical institutions;the second part focuses on the legal relationships between the three major parties in a commercial insurance contract,namely the insurer,the insured and the medical institution,as well as the legal relationships between the insurance companies and medical institutions and other competitive entities in the market;the third part,based on the analysis above,discusses the changes of the rights and interests of the three parties under the new investment mode,and restructures the protection mechanism of medical insurance consumers accordingly;the fourth part summarizes five points and recommendations that need to pay attention to under the new mode of insurance companies' investing in its designated hospitals,including entity independence,information management,market operations,supervision and regulation and consumer protection.This paper argues that even under the new circumstances that the insurance companies invest in its designated hospitals,the “designated hospitals” clause in the commercial insurance contract shall still be of rationality and necessity;however,as the performing third party,a medical institution which is invested by such insurance company,along with the insurance company,shall bear the obligation of prior explanation in full and obtain the explicit prior consent of the insurance consumers,in order to effectively protect the interests of insurance consumers in this new mode.