Research On The Risk Management Of Group Health Insurance In China

Since the reform and opening up,China's national economy has developed rapidly and now enters the stage of high-quality development.The insurance industry is also in the golden period of great development due to the positive influence of national policies.In particular,the business of commercial health insurance and group insurance develops rapidly.In 2014,the "new ten articles" was promulgated,encouraging insurance companies to actively develop various kinds of medical treatment,disease insurance,disability income loss insurance and other commercial health insurance products that are urgently needed by the people and related to people's livelihood.Under the policy call,commercial health insurance has grown rapidly.In 2015,circ issued the notice on promoting the healthy development of group insurance to promote the professional development of group insurance.At the 2018 boao Asian economic forum BBS,China stressed the opening of the scope of business for foreign insurance companies.Subsequently,the headquarters of allianz group decided to set up allianz(China)insurance group co.,LTD in Shanghai,which is the second wholly foreign-owned life insurance company after aia.The opening of foreign investment in insurance can promote the professional development of China's insurance industry to a great extent.With the country's top-level design paying more attention to the insurance industry,the group insurance business has developed rapidly,but the market is still "individual insurance,light group insurance",which is largely due to the high cost of group insurance business.Therefore,it is the key to reduce the operating cost of group insurance business so as to promote the comprehensive and coordinated development of the insurance industry.There are many factors that affect the development of group health insurance,including the attributes of groups and the characteristics of health insurance,which determine the complexity of risk factors and lead to incomplete risk control of group health insurance by insurance companies.This paper firstly analyzes the group attributes of group insurance and differentiates it from individual health insurance.Secondly,it summarizes the risk management of the insurance industry.On this basis,it studies the development status of group health insurance in recent years.Then combined with thedevelopment of the status quo analysis of the risk factors and problems in the process of its operation.In the analysis of risk factors,it mainly analyzes the operational risks of insurance companies,specific risks of group health insurance and social and environmental risks.The experience of American managed medical risk management and control is comprehensively evaluated.Combined with the specific national conditions of China's insurance industry development,the concept of managed medical treatment guiding customers to carry out health management is used for reference.The risk assessment before health plan work is carried out and the management is strengthened in advance.In terms of countermeasures,it is mainly to establish a sound risk identification system for group health insurance business,from underwriting to claim settlement,from sales personnel to the company's in-house technical personnel,to audit layer upon layer,quickly locate risks,transfer risks,and estimate losses.Increase the efforts of talent training,with the help of artificial intelligence to make the professional development of insurance companies to the next level.We will promote the sound development of the group health insurance business in China.