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In November 2021, Ms.
Li, who lives in Rizhao, insured her father with "Rizhao Warm Heart Insurance"
.
This is an urban inclusive medical insurance customized for Rizhao citizens, with a maximum of 3.
5 million yuan of protection
for 109 yuan a year.
What Ms.
Li values most is that "Rizhao Warm Heart Insurance" has no restrictions on the insured population - her father was diagnosed with advanced lung cancer in 2018 and had a recurrence in September 2021, and he is no longer eligible
to purchase ordinary commercial insurance.
What makes Ms.
Li even happier is that the "Rizhao Warm Heart Protection" also has a specific high drug cost protection, with a deductible of 15,000 yuan, a pre-existing condition compensation ratio of 60%, and a coverage amount of 1 million yuan
.
This is like a timely rain
for Ms.
Li's father, who has no obvious effect of chemotherapy after the cancer has recurred and urgently needs new treatment.
"At that time, I felt that my father was saved, and our family was saved!" Ms.
Li said
.
In December 2021, Ms.
Li's father used the targeted drug Phuket
.
The original price of more than 60,000 yuan a bottle of self-paid drugs, after the "sunshine warm heart protection" reimbursement, patients only need to pay more than 20,000 yuan
at their own expense.
Ms.
Li introduced that her father's body recovered well
after taking special drugs.
"When I went for the examination, the doctor said that the tumor was significantly smaller, and when I checked the signs, the indicators were normal
.
"
The story of Ms.
Li's family is one of more than 140 million Huimin Insurance participants
.
Statistics from the Insurance Association of China show that by the end of 2021, Huimin Insurance covered 28 provinces across the country, with a total of 140 million people enrolled in the insurance and premiums of about 14 billion yuan, providing 176 million insurance protection
for the elderly aged 60 and above.
[1]
Huimin Insurance, a city-customized commercial medical insurance born in 2015 and rapidly developed in 2020, not only greatly reduces the financial burden of patients, but also brings more treatment options
.
With the joint efforts of government departments and commercial enterprises, Huimin Insurance has not moved towards the "death spiral" that industry insiders feared at first, but has become an important supplement to
the multi-level protection system.
On December 14, 2022, the latest academic achievement "2022 City Customized Commercial Medical Insurance (Huimin Insurance) Knowledge Graph" (hereinafter referred to as the "Knowledge Map") led by Xu Xian, Dean of the Department of Risk Management and Insurance of Fudan University, was successfully released
.
It is understood that based on the team's continuous tracking of Huimin Insurance for three years, the "Knowledge Map" counted a total of 263 Huimin Insurance products from 29 provincial-level administrative regions, highly summarized 9 data labels, and put forward a predictable "three views and three questions"
.
With the help of this academic research result, it is particularly meaningful
to re-sort the value of Huimin Insurance to multi-level protection and gain insight into the development trend of products.
What value has Huimin Insurance brought to patients in the past seven years?
From the release of Shenzhen Supplementary Medical Insurance for Major Diseases in 2015 to the beginning of 2020, Huimin Insurance products have experienced a long dormancy period, with only 4 new models
added in 5 years.
Until 2020, in the publicity of "government guidance, low premium, high sum insured, and unlimited insured people", Huimin Insurance began to expand
rapidly.
According to the data of the Knowledge Graph, as of December 1, 2022, a total of 263 Huimin Insurance products have been launched nationwide, covering 29 provincial-level administrative regions, of which 123 new Huimin Insurance products were added from May 31, 2021 to December 1, 2022 alone
.
The enthusiasm of the industry is evident
.
Why can a commercial insurance with an average price of less than 100 yuan cause such an uproar?
In fact, after seven years of development, Huimin Insurance has jumped out of the framework
of "commercial insurance".
According to the Knowledge Graph, the participants of Huimin Insurance have formed a development model
in which "government departments + insurance companies + third-party platform companies" participate together.
of "commercial insurance".
According to the Knowledge Graph, the participants of Huimin Insurance have formed a development model
in which "government departments + insurance companies + third-party platform companies" participate together.
With the participation of many parties, Huimin Insurance is not only a protection tool, but also provides financial payment
for insured patients.
At the same time, it also plays the role of the "baton" of medical services, bringing more accurate medication guidance, medication selection, health management and other services
to the insured.
Taking Meixin Health mentioned in the Knowledge Graph as an example, the company's core service layout mainly includes providing insured people with drug services such as off-list drug services and new special drug direct services; Online consultation, physical examination services, health science popularization and other medical value-added services; As well as claims settlement services
such as adjustment system support, manual review, and direct claim assistance.
Wan Xiaolong, CMO of Meixin Health, told the health industry that in the future, Huimin Insurance is expected to become a new entrance for the general public to obtain inclusive health services, and is the origin of connecting the local medical ecology
.
This not only includes advanced pharmaceutical and medical device services, but also becomes a "connector"
between medical institutions and patients, medical and health services and ordinary people.
.
This not only includes advanced pharmaceutical and medical device services, but also becomes a "connector"
between medical institutions and patients, medical and health services and ordinary people.
The data from the Knowledge Graph confirms this trend
.
The data shows that the specific protection responsibilities and value-added services of Huimin Insurance products have expanded at the same time
.
Among the specific protection responsibilities, many insurance items such as "ultra-high medical expenses, proton heavy ion costs, new coronary pneumonia related liabilities, malignant tumor related liabilities, rare disease related liabilities, and advanced therapy costs" are included
.
In the section of specific high-value drug protection, the Knowledge Graph summarizes that Huimin Insurance products include more than 300 kinds of special drugs
at home and abroad.
In terms of value-added services, it mainly includes drug services, consulting services, medical services and preventive screening services
.
Supplement with the difference between basic medical insurance Huimin Insurance has become the core force of multi-level protection
Supplement with the difference between basic medical insurance Huimin Insurance has become the core force of multi-level protectionThe report of the 20th National Congress of the Communist Party of China pointed out that the social security system is the safety net of people's lives and the stabilizer
of social operation.
It is necessary to improve the multi-level social security system, expand the coverage of social insurance, promote the orderly connection of multi-level medical security, and actively develop commercial medical insurance
.
Combined with a number of previous heavy policy documents related to medical security, whether it is the "14th Five-Year Plan" National Health Plan, the "14th Five-Year Plan" for universal medical security, or the "Health Insurance Management Measures" and "Healthy China 2030" planning outline dating back to a few years ago, it is not difficult to see that the policy is continuously and consistently encouraging the development of
commercial health insurance.
However, at present, the proportion of commercial insurance financing in China is still low, only 5.
3%
in 2021.
Public fundraising led the way, at 67 per cent, and personal out-of-pocket payments accounted for a relatively large proportion of 27.
7 per cent
.
[2]
Inclusive health insurance, represented by Huimin Insurance, is a new entry point for many people to contact inclusive health protection and has become a strong supplement
to the multi-level medical security system.
This aspect is reflected in the value of
guarantees.
China's basic medical insurance has always adhered to the principle of "wide coverage and basic protection", which is certainly a medical insurance system in line with China's national conditions, but it cannot avoid the contradiction
between the limited reimbursement capacity of basic medical insurance and the unlimited demand of patients for new technologies and new drugs.
guarantees.
After years of development, Huimin Insurance has mainly extended from the supplementary reimbursement of basic medical insurance to the responsibility of external medical insurance, and enhanced the protection through the list of high-value special drugs
.
According to the data of "Knowledge Graph", among the 228 Huimin Insurance products covering "hospitalization liability within medical insurance", 72% of the products have a compensation ratio of more than 70%; Among the 106 products covering "out-of-medical insurance hospitalization liability", 63% of the products have a compensation ratio of more than 50%; Of the 206 products that covered "specific high drug liability", 62% paid more than 70%.
Combined with the characteristics of Huimin Insurance "supporting individual account deduction and personal account purchase, encouraging individuals to purchase for family members, opening up electronic medical record claim channels, unifying basic medical insurance and serious illness insurance compensation information, and promoting one-stop claim settlement", the Knowledge Graph believes that Huimin Insurance has promoted the accelerated integration
of multi-level medical security systems.
On the other hand, Huimin Insurance also brings industry value
.
Innovative drugs and medical devices are always expensive, but they are often the last glimmer of hope
for relapsed and refractory patients.
Huimin Insurance not only brings economic compensation to patients and promotes medical access by means of drug catalogues and specific protection responsibilities, but also becomes a new entry point for innovative drugs and devices after entering China, promoting the improvement of the industry
.
.
Taking the innovative tumor therapy CAR-T as an example, its price of up to 1.
2 million yuan is difficult for many patients' families to afford.
Wang Liqun, former CEO of Fosun Kate, once told the media that under the existing medical insurance negotiation model, CAR-T is difficult to enter
.
If you want to benefit more patients, you may have to take the path of commercial insurance, such as solving the problems
accessible to patients through Huimin insurance.
According to data from Meixin Health, as of September 2022, Meixin Health has incorporated CAR-T innovative therapies into the "Huimin Bao" project in 27 cities, reducing the treatment burden
of lymphoma patients by more than 10 million yuan.
[3]
While improving medical access and providing affordability for innovative drugs and devices, Huimin Insurance also plays an important role
in promoting the reform and development of basic medical insurance.
Taking the 2021 version of the special drug list of Shanghai Huhuibao as an example, 7 drugs have been included in the national basic medical insurance drug list, which has played a good role in the pilot and
pilot.
Third-party services for sustainable development Meixin Health becomes the "glue" of all parties
Although Huimin Insurance has brought irreplaceable value to patients and the medical industry, it still cannot get rid of the industry's concerns
about the "death spiral".
That is, pre-existing conditions are insurable and compensable, attracting the participation of sick bodies, healthy bodies do not take risks, the sense of gain is reduced, and they are more inclined to withdraw, resulting in a reduction in the scale of premiums, income and expenditure, unable to achieve the value of insurance risk sharing, and it is difficult to be sustainable
.
Based on the perennial observation of Huimin Insurance's operation model, Professor Xu Xian, Dean of the Department of Risk Management and Insurance of Fudan University, gave the answer: balancing the sense of health gain and the level of pre-existing disease protection is an important means
for Huimin Insurance to cope with the death spiral.
That is, on the one hand, multi-dimensional improvement of the sense of health is the key to
the benign operation of Huimin Bao.
On the other hand, more products are being included in patients with pre-existing conditions, while imposing restrictions, increasing management capacity, and seeking a balance
between inclusiveness and sustainability.
for Huimin Insurance to cope with the death spiral.
Wan Xiaolong analyzes the health industry from the practical level, and to cope with the death spiral, it is necessary to do a good job in the refined management
of products and services.
On the one hand, through preferential rates, deductible adjustments, health management value-added services, etc.
, improve the sense of insurance application and acquisition of healthy individuals, and enhance their willingness to participate in and renew insurance; On the other hand, for people with pre-existing conditions with a high proportion of claims, do a good job in precise product design, and fully consider the balance
between their medical costs and accurate pricing.
of products and services.
On the one hand, through preferential rates, deductible adjustments, health management value-added services, etc.
, improve the sense of insurance application and acquisition of healthy individuals, and enhance their willingness to participate in and renew insurance; On the other hand, for people with pre-existing conditions with a high proportion of claims, do a good job in precise product design, and fully consider the balance
between their medical costs and accurate pricing.
To this end, Meixin Health provides differentiated services
for different insured groups such as healthy individuals, the elderly, substandard bodies, and sick persons.
"That is to say, improve the 'preferential services' of Huimin Insurance, that is, ordinary people need health science popularization, vaccines, and physical examination services, chronic disease groups need more convenient and preferential access to medicines, and sick people are more interested in
medical services.
" Wan Xiaolong explained
further.
Taking the Urban Inclusive Health Alliance launched by Meixin Health as an example, the territorial approach has brought more sense
of gain to regional participants.
It is worth mentioning Suhuibao 2023, the project launched the Huihui Guardian National Health Service Action, bringing 3 series and 12 health services
to the insured.
In terms of the refined management of diseased bodies, Wan Xiaolong believes that the management mechanism of the commercial insurance catalogue is an important tool, which can make the limited capital pool more efficiently paid for services and drugs with greater clinical treatment value and pharmacoeconomic value
.
The recently released Guiding Opinions on Promoting the High-quality Development of Inclusive Insurance (Draft for Comments) puts forward high requirements for inclusive insurance with low rates, wide coverage and scenario-based scenarios, and it is necessary to adhere to the combination of universal services and universal benefits, the combination of market mechanisms and policy support, and the combination of
innovative development and risk prevention.
This puts forward higher requirements
for Huimin Insurance, which has many participants.
How to link all parties to form synergy is also a must-answer question
in front of sustainability.
This requires a third-party platform with resource-linked infrastructure and operational capabilities
for territorial inclusive insurance.
The third-party platform that best understands the needs of all parties and has professional capabilities and resources is undoubtedly the best "glue"
.
In this regard, Meixin Health has made many attempts
.
Wan Xiaolong introduced that third-party platforms can do a lot
as "connectors".
For example, linkage insurance companies to deeply explore the health needs of inclusive people, linkage with local contractors of Huimin Insurance to build an urban inclusive health alliance, and linkage with the pharmaceutical and health industry chain to help insurance companies provide sensible services and solutions with lower budgets.
.
.
In view of the imbalance in the regional protection of Huimin Insurance, Wan Xiaolong believes that on the one hand, this is a phased status quo, and with the improvement of economic level, regional protection will gradually increase
.
On the other hand, it also puts forward higher requirements for Huimin Insurance participants, which need to localize and customize city-specific products and continuously optimize them to make them more in line with regional needs
.
However, as an inclusive insurance, Huimin Insurance cannot be expected to solve everything
.
In Wan Xiaolong's view, in the future, Huimin Insurance will become the entrance to medical services in local cities, and it is necessary to build a 1+N health security ecology
centered on Huimin Insurance.
1, that is, Huimin Insurance, N is a supplementary guarantee and value-added health service
related to Huimin Insurance.
"In this way, we can better and more three-dimensionally meet the health security needs
of the people.
" Wan Xiaolong said
.
Data source:
Data source:[1]2021 China Insurance Industry Social Responsibility Report,
[1]2021 China Insurance Industry Social Responsibility Report,[2] Zheng Bingwen: If commercial insurance does not go up, medical individuals cannot pay down.
[2] Zheng Bingwen: If commercial insurance does not go up, medical individuals cannot pay down.
[3] World Lymphoma Awareness Day 2022 | Meixin Health helps CAR-T therapy become accessible, and "Huimin Protection + Health Service" jointly protects patients' hopes.
[3] World Lymphoma Awareness Day 2022 | Meixin Health helps CAR-T therapy become accessible, and "Huimin Protection + Health Service" jointly protects patients' hopes.
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