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Research On Health Management Of Commercial Health Insurance In China

Posted on:2020-10-13Degree:MasterType:Thesis
Country:ChinaCandidate:G F HuangFull Text:PDF
GTID:2439330590493119Subject:Insurance
Abstract/Summary:PDF Full Text Request
With the development of economy and the improvement of living standards,people pay more and more attention to their health.However,in recent decades,on the one hand,chronic diseases are increasingly harmful to physical and mental health,on the other hand,medical costs are rising,which leads to people's demands for health can not be met.As an important supplement to China's medical system,commercial health insurance plays an important role in solving people's medical and health needs.However,the current development of commercial health insurance in China is not optimistic.Besides the late start and lack of experience,the unique adverse selection and moral hazard in its own business process are also the important reasons for various problems.So how to solve this kind of problem? From the experience of foreign commercial health insurance development,health management is an effective way to solve this problem.Therefore,whether it is to solve their health problems at the public level or to maintain their own stable development at the commercial health insurance level,it is the only way to learn from foreign experience to carry out health management.At present,China's commercial health insurance has carried out a variety of practices on the road of health management,and its partners are mainly medical institutions,medical examination companies and professional health management organizations.Unfortunately,the effect is unsatisfactory.Community Health Service Institutions(hereinafter referred to as CHSI)as China's basic public health service institutions,not only has its own unique advantages in providing health management,but also the government is constantly strengthening its investment in health management.In addition,through the survey of residents,it is found that,regardless of the insured.Or non-insured persons,they all have the intention of receiving health management services in CHSI.In summary,the author studies CHSI as a new cooperative subject of health management in commercial health insurance.The general idea of this paper: Starting from the necessity and feasibility of the cooperation between commercial health insurance and CHSI in health management,combined with the experience of American Health Maintenance Organization in health management and the actual situation of Chinese commercial health insurance,the author will explore commercial health care in detail from six aspects: cooperation object,cooperation mode,payment mode,service population,service form and service content.Health insurance and CHSI cooperate to carry out health management mode.Finally,starting from the three main bodies of government,insurance company and CHSI,according to the factors affecting the implementation of the model,the corresponding suggestions are put forward.There are six chapters in this paper.The first chapter is introduction.Firstly,the research background,purpose and significance of this paper are elaborated;secondly,in the literature review section,the significance of health management,the background,methods and significance of health management in commercial health insurance are sorted out,and the experience and problems are summarized to obtain the inspiration of this study;finally,the content and methods of this study are introduced,and the feasibility of this paper is put forward.Innovation and inadequacy of energy.Chapter ?: An overview of health management.This chapter mainly clarifies the related concepts and subjects involved in this study.Firstly,the connotation,basic content and steps of health management are elaborated.Then,the specific practice of health management in China is introduced.Finally,the practice of health management in CHSI is introduced with the two models of "Know your health" and "General Practitioner" as examples.The third chapter analyzes the necessity and feasibility of China's commercial health insurance and community health service agencies to carry out health management.In terms of necessity analysis,the author elaborates on China's commercial health insurance from four aspects: the development status of commercial health insurance itself,the current health insurance management health management problems,the status quo of the elderly society and the status quo of chronic diseases.CHSI cooperates in the need for health management.In terms of feasibility,the author mainly analyzed from four aspects.1.Analyzed the government's emphasis on CHSI's health management and the unique advantages of CHSI's health management,indicating that CHSI meets the needs of commercial health insurance for health management cooperation.2.Analyze the current status of CHSI and clarify that CHSI also has a need to cooperate with commercial health insurance.3.Analysis of the development of China's grading diagnosis and treatment model provides favorable external conditions for commercial health insurance and CHSI cooperation in health management.4.Based on the questionnaire survey of residents,151 of the 179 people who purchased commercial health insurance were expected to provide health management services.Among the 151 people,79 were willing to accept the free insurance provided by the insurance company at CHSI.Health management services accounted for 52.31%;of the 457 people who did not purchase commercial health insurance,225 were willing to buy insurance companies' health management services at CHSI at a low price,accounting for 49.23%.It can be seen that both the insured and the non-insurance have the intention to receive health management services at CHSI,so there is a market demand for commercial health insurance and CHSI to conduct health management.Through the analysis of the above five aspects,it can be seen that China's commercial health insurance and CHSI cooperate to carry out health management with certain feasibility.The fourth chapter draws on the experience of foreign countries.This chapter introduces the health management organization of the United States and the South African discovery company to carry out health management experience,mainly from the implementation of health management mode of operation,the implications of China's commercial health insurance health management.Chapter 5: China's commercial health insurance and community health service agencies cooperate to explore the operation mode of health management.This chapter focuses on how commercial health insurance works with CHSI to conduct health management.Based on the questionnaire analysis of residents,the experience of American HMO experience and related literature analysis,the author mainly discusses from six parts.The first part of the choice of cooperation objects.Due to the large number of CHSI,commercial health insurance must be targeted when selecting.Based on the analysis of related literatures,the author summarizes the factors affecting residents' satisfaction with CHSI,and then choose the appropriate CHSI based on these influencing factors.As a partner.The second part of the choice of cooperation mode.Firstly,it introduces several models of health management in China's commercial health insurance: Internet model,self-built model,shareholding holding model,strategic cooperation model,and then determines the cooperation model between commercial health insurance and CHSI through analysis of advantages and disadvantages.The third part of the choice of payment methods.Since different payment methods have different effects on supplier behavior,the method of commercial health insurance to pay for CHSI health management fees is determined by summarizing the research of relevant scholars.The fourth part of the service object.According to the fact that most of the insured persons who purchase health insurance in China are ordinary customers and a simple economic reasoning,the population targeted by the health management of commercial health insurance and CHSI is determined.The fifth part of the service form and the sixth part of the service content.Based on the questionnaire survey of residents in Section 3.2.4,the service forms and contents of commercial health insurance and CHSI for health management were determined.The sixth chapter is about the proposal of China's commercial health insurance and community health service agencies to carry out health management.In order to promote the development of cooperation,this chapter starts from the three main bodies of the government,insurance companies and community health service agencies,and puts forward corresponding suggestions.1.The government: proposes relevant suggestions from four aspects: strengthening policy support,coordinating the interests of various subjects in the diagnosis and treatment,establishing a unified health information system,and strengthening the construction of a family doctor system;2.Insurance companies: respectively The health management service system and network system,the establishment of effective supervision and incentive mechanisms,and the cooperation between insurance companies,from point to point,gradually develop cooperation with community health service organizations,and actively seek cooperation with social medical insurance.Relevant suggestions;3.Community health service institutions: Suggestions on strengthening the promotion of health management of community health service institutions and commercial health insurance,accurately dividing insured persons,and implementing tiered management.Possible innovations of the paper:The cooperative objects chosen by commercial health insurance for health management are transforming cooperation with hospitals,medical institutions,professional health management companies,and adopting cooperation with community health service institutions.Secondly,through questionnaire survey and a large number of literature reading,this paper explores the mode of how the two cooperate in health management,and puts forward corresponding suggestions according to the factors affecting the implementation of the mode.
Keywords/Search Tags:commercial health insurance, health management, community health services institutions, cooperative
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