Pratt & Whitney Insurance: Is it on the eve of the outbreak of commercial health insurance that swept 50 million people?

Internet celebrity insurance, inclusive insurance, continues to conquer cities.

In the past few months, with the low price of less than 100 yuan and the promised high insurance coverage-over one million, a new type of commercial health insurance-inclusive insurance has swept nearly 40 cities, and the number of people insured It broke 10 million quickly.

In one year, the data has doubled several times.

This is a wave of inclusive insurance booms across the country after the "Opinions on Deepening the Reform of the Medical Security System" issued by the State Council in March last year.

However, the enthusiasm is far from stopping there.

It spread from Guangdong to Jiangsu and then to Zhejiang.

And more cities that were still on the sidelines last year have taken action this year, from watching to accepting, and hitting it off with commercial insurance companies.

The inclusive commercial supplementary medical insurance that Zhejiang has launched across the province has covered more than 14 million people in the province in just a few months.

Unlike inclusive insurance, which was dominated by commercial insurance companies, which swept the country last year, the inclusive commercial medical supplement insurance launched by Zhejiang Province is the first product under the guidance and support of the Medical Insurance Bureau.

As of March 16 this year, Hangzhou, Shaoxing, Jinhua, Quzhou, Lishui, Zhoushan, and Wenzhou have introduced different local inclusive insurance plans.

The enthusiasm of Pratt & Whitney has made the tepid commercial health insurance market lively: Since 2015, a total of 21 insurance companies including Ping An, China Life, CPIC P&C and PICC have entered the market.

Someone has calculated that the current market for inclusive insurance is about more than 4 billion yuan, but according to this development speed and popularity, in three or four years, the market for inclusive insurance alone will be 30 to 40 billion yuan.

This is a blue ocean market that practitioners in the Chinese commercial insurance market have never thought of: Inclusive insurance will one day become the object of admiration by governments across the country.

In some cities, the situation of "one city with two guarantees" or even "one city with three guarantees" has occurred, and the degree of market competition is shocking.

However, from the initial emergence of commercial-led inclusive insurance, government-led inclusive insurance has become the mainstream in the market.

Under the background that there are still gaps in the basic medical security system and commercial insurance cannot achieve high coverage, inclusive insurance, as a product that fills the gap between basic medical insurance and commercial insurance, has gradually become a kind of product that is embraced by the politicians everywhere.

In some places that have entered the market this year, inclusive insurance is no longer attracting attention with low-cost participation fees of tens of yuan and huge compensation.
Policy designers are more cautious and standardized.
In order to reduce the risk that insurance companies may lose money, they have increased their participation.
The cost has been increased from tens of yuan to more than 100 yuan; the deductible is reduced from tens of thousands to a few thousand, so that more than 20% of the local people, instead of only 5% of the people, can use universal insurance.

However, inclusive insurance of this nature is different from any commercial insurance in the global market in the past: the nature of inclusiveness for the people and the conflict of interests of insurance companies will always exist.
How to reconcile this contradiction will normalize inclusive insurance.
The latter is the most difficult problem.

What is the actual operating status of Inclusive Insurance? Is it profit or loss? How big is the influence of various factors, and can it be guaranteed that the insurance company will operate with “guaranteed and meager profit”? Are these factors sufficient to ensure the lasting and stable operation of Inclusive Insurance? These core issues remain to be explored.

The lit commercial health insurance market

"Everyone wants to take medical insurance for everything, but basic medical insurance should be basic.
" This is the anxiety of the entire industry.

Indeed, people rely too much on health insurance.

The 2018 movie "I am not the god of medicine", let people know about the high-priced innovative drugs represented by Gleevec.
Subsequently, the Medical Insurance Bureau held relevant meetings, and anti-cancer drug negotiations were put on the agenda.
In the end, 18 kinds of high-priced anticancer drugs were negotiated and 17 kinds were entered into medical insurance.
Since then, people have even placed their expectations for the use of high-priced drugs and rare disease drugs on medical insurance.

Another major event that occurred last year was the solicitation of opinions on the reform of medical insurance personal accounts, which triggered a huge public opinion rebound for a while.

In short, in the years when the Chinese had universal medical insurance, medical insurance has undertaken more functions than payment: solving social problems, people's livelihood problems, and even rising to political problems, used to evaluate whether a local government's commitment to the people is sincere enough.
These are all confirmed, the basic medical insurance has been placed so much expectation that it is overwhelmed.

The results are obvious from the two sets of data.
The first group is that in the past ten years, China's medical insurance financing level has only been about 2% of GDP, and the coverage of more than 96% of nationals covers more than 60% of the medical expenses.

This means that China is using a low level of financing to meet the medical needs of more people.

In the context of aging and the continuous introduction of new drugs and equipment, medical insurance pressure is a common problem faced by countries all over the world.
But in developed countries, commercial health insurance, as another important payer, can solve the problem of personal medical payment to avoid an excessively high personal out-of-pocket ratio.

The situation in China is that the long-term development of commercial health insurance has been slow.
Since its entry into the Chinese market in 1995, commercial health insurance has long maintained its awkward status as an additional life insurance product.
It is difficult for pure protection health insurance to be favored by consumers.
On the contrary, people are more willing to buy life insurance products that use wealth management as a selling point.

Until 2019, of the total medical expenditures of Chinese residents, commercial insurance payments accounted for only 5.
6%, basic medical insurance payments accounted for 50%, and personal expenditures 44.
3%-while this figure was only 12.
4% and 9.
8% in Germany and France.

Compared with basic medical insurance, commercial insurance is still a long way from becoming a rising payer.

Except for the declining million-dollar medical insurance, there are few star products with high acceptance in the health insurance field.
Until 2020, urban inclusive insurance turned out to be a phenomenon-level symbol-covering more than 100 cities across the country in more than half a year, harvesting more than 50 million insured persons, and realizing more than 4 billion premium income.

Wang Pingyang, deputy inspector of the Zhejiang Provincial Medical Security Bureau, keenly realized that this is the awakening of public commercial insurance awareness.
For the Medical Insurance Bureau, this is undoubtedly a good thing to reduce stress.

He calculated that the average annual funding standard for employee medical insurance in Zhejiang in 2019 is 4422 yuan, and that for urban and rural residents is 1252 yuan.
The funding standard is already very high, but the security is not enough.
If on this basis, the funding standard is increased by 100 yuan, the public's opinion will definitely be very big.
However, another method and mechanism can provide people with an extra layer of protection, but the result may be different.

Soon, "supporting business and insurance" became a consensus within the Zhejiang Medical Insurance Bureau.

In a sense, the commercial supplementary medical insurance launched by Zhejiang uses official credibility to endorse and pave the way for China's commercial insurance, hoping to reverse the pattern of weak commercial insurance.

Wang Pingyang told Jianwen at 8:00 that Zhejiang’s commercial insurance claims accounted for a very low percentage of the entire medical and health expenses.
Last year it was only 3%.
In developed countries, this figure is more than 20%.
In the 14th Five-Year Plan for Medical Security in Zhejiang Province, Zhejiang Province intends to use five years of hard work to increase the proportion of Zhejiang’s commercial insurance compensation in total medical expenses from 3% to about 10%.

Will the Zhejiang model of the medical insurance bureau's admission spread across the country?

Before the establishment of the Zhejiang Medical Insurance Bureau, when Wang Pingyang was still in the Zhejiang Provincial Department of Human Resources and Social Security, the state’s basic medical insurance could not solve the protection of serious and rare diseases for some people, and the phenomenon of poverty caused by illness had already appeared.

The Department of Human Resources and Social Security faced this predicament and took the lead in launching a "serious illness insurance" covering 15 special medications in the country in 2015.

When the adjustment frequency of the National Medical Insurance Negotiation Catalogue was adjusted to once a year, and more and more serious illness special envoy drugs were included in the National Medical Insurance Catalogue, Wang Pingyang believed that the serious illness insurance policy had completed its historical mission.
He has always believed that the basic medical insurance system should "guarantee basic and serious illness, it is not a panacea.
" "In the case of insufficient commercial insurance participation, the government can introduce special policies such as critical illness insurance for people with serious illnesses, but the ideal state is that commercial insurance should be involved," he said.

A few years ago, at the same time when he promoted Zhejiang Province’s critical illness insurance, he also negotiated with major commercial insurance companies to discuss whether to introduce a supplementary insurance for basic medical insurance that is led by the government and operated by commercial insurance companies.
But at that time, commercial insurance companies were not able to participate in such a large-scale medical insurance product, so it stopped.

Until 2020, the Zhejiang Medical Insurance Bureau has been established for two years, and inclusive insurance suddenly became popular.
Wang Pingyang, who served as the deputy inspector of the Zhejiang Medical Insurance Bureau, confirmed two facts: the people have a huge demand for such products with low payment and high compensation.
; Commercial insurance companies take 30% or more of the high intermediary fees and operating expenses in the insurance coverage, and launch such products, which means that such products are profitable, risks can be predicted, and commercial insurance companies have motivation Do it.

In February 2020, the Central Committee of the Communist Party of China and the State Council issued the "Opinions on Deepening the Reform of the Medical Security System", reiterating the goal orientation of establishing a multi-level medical security system, and the high-level direction is clear.

A few months later, the Zhejiang Provincial Medical Insurance Bureau, together with the Banking and Insurance Regulatory Commission, Finance and other departments, jointly launched the Zhejiang Commercial Supplementary Medical Insurance, which is the country's first inclusive insurance led by the provincial medical insurance department.

Different from the establishment of "Critical Illness Insurance" in 2015 in Zhejiang Province, the Department of Human Resources and Social Security of the Zhejiang Provincial Government, together with relevant departments, organized experts to directly participate in the price negotiation of special medicines for serious diseases with enterprises.
This time, in the design of commercial supplementary medical insurance, the Zhejiang-level medical insurance department requires the medical insurance departments of each city to promote, guide, support and supervise the commercial supplementary medical insurance.
It is clear that the operational responsibility of commercial supplementary medical insurance lies with commercial insurance companies.
If the commercial insurance is not operated well, the compensation cannot be completed, and the government's medical insurance fund will not be able to find the bottom.

"The Provincial Government Medical Insurance Bureau only sets out a policy design, general direction guidance, and does a good job in the supervision of commercial insurance companies, and will not interfere too much in the operation of commercial insurance.
" Wang Pingyang explained.

Research by Professor Yu Baorong’s team from the School of Insurance of the University of International Business and Economics found that the number of people participating in inclusive insurance, which is dominated by commercial insurance companies, is different.
In the region, even Jiaxing "Huijiabao" went online only one month after it entered the maintenance state and cannot go online again.
Guangdong Huiminbao's participation rate within the 2020 insurance period is only about 4.
7%.
But as long as products with strong policy (high government participation), the residents' participation rate is high.

After the introduction of the inclusive commercial medical supplement insurance in Zhejiang, one of the most obvious and intuitive changes is the large-scale participation of the number of insured persons.
As of March 16, 2021, among the eight prefecture-level cities in Zhejiang that have initiated urban insurance, the Lishui City, which has the highest insurance rate, is close to 90%, which is almost twice the average participation rate of general commercial health insurance.

Zhejiang’s attention and promulgation of guidance is just the epitome of the intensified involvement of medical insurance bureaus across the country in the design and supervision of inclusive insurance products.

Wan Xiaolong, general manager of the health policy and insurance division of Magnesium, summarized the participation methods and levels of participation of local governments in inclusive insurance into three types.
Government participation in product launch conferences and encouragement of innovation can be regarded as “government support”; and government participation at the top level Designing and providing product promotion support and even service guarantees can be called "government guidance"; on the basis of guidance, the government participates in increasing the insurance participation rate and coverage, which can be regarded as a "government-led" model.

"The changes started in the fourth quarter of last year.
" Wan Xiaolong observed that before this, it was mostly a simple "government support" model, and since then, it is more of a true "government guidance" and "government-led" deep participation model.

What has changed simultaneously with government participation is product liability and product pricing, as well as financing coverage.
Take Zhejiang as an example.
In order to emphasize the "inclusiveness" of its products, it has realized insured and indemnable diseases with diseases, and accordingly, the price has risen.
On the other hand, the government hopes that a larger proportion of the money raised can be used for compensation.

Many insurers said that this move in Zhejiang Province has allowed other hesitating medical insurance departments to boldly start negotiations with commercial insurance companies.
"The inclusive insurance market has changed very much, and all regions will follow this model in Zhejiang.
"

An official from the Medical Insurance Bureau of the Southwest region believes that other provinces will force the provinces that have not done so after the introduction of government-led universal insurance.
He gave an example: "For example, in the capital cities of the provinces, among the three southwestern provinces, the surrounding cities do The decision makers who have not made it will be unable to sit still.
"

Will inclusive insurance encounter the industry's "death spiral"?

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