Insurance | Focus on insurance innovation
7/31, which was originally the insurance deadline for the 2022 version of " Shanghai Huibao ". According to the department of insiders, as of July 31, a total of 6.45 million people participated in the insurance purchase of the 2022 version of "Shanghai Huibao", lower than the 7.39 million people in the first year of "Shanghai Huibao". The insurance period originally ended on July 31 was extended to August 20, and the premium and protection period remain unchanged.
total number of insured persons did not reach last year's level, and it is still far from the previously reported insurance target of tens of millions, which is both unexpected and reasonable. Huiminbao swept over more than 50 cities in just about one year. With its "universal" characteristics and government "station support", Huiminbao has become a phenomenal hot insurance product. However, after carefully checking the details of Huiminbao in various places, it can be found that Huiminbao still has many compensation conditions for residents, resulting in some insured residents having a weak sense of gain. So how can Huiminbao, who has arrived in the stage platform period, be well received and popular? The author seeks a glimpse through public data and interviews with relevant personnel within the industry.
1.0 The 2020, when Huiminbao is in line with the times, is considered to be the "first year of Huiminbao". Based on the internal and external situations, it is not difficult to find that the outbreak of welfare insurance has three main driving forces: policy push, demand internal force and external pressure.
On October 24, 2020, the Ministry of Civil Affairs predicted that during the 14th Five-Year Plan period, the national population of elderly people aged 65 and above will exceed 300 million. The elderly have decreased their immune ability, increased risk of illness, heavier medical expenses, and a higher demand for commercial health insurance. However, most commercial health insurances currently have strict age restrictions and health notification restrictions. The elderly population often suffers from various chronic diseases. As a special group with extremely high prevalence, they often cannot participate in commercial health insurance.
According to the "2020 National Medical Insurance Development Statistical Bulletin", the number of people participating in basic medical insurance nationwide was 1361.31 million, with the insurance rate stable at more than 95%. The total annual expenditure was 2103.2 billion yuan, an increase of 0.9% over the previous year, accounting for 2.1% of the GDP that year. From 2012 to 2019, the surplus rate of residents' medical insurance funds declined significantly, from 23% to 4.5%. Behind the nearly 20 percentage points, the compensation pressure faced by the National Medical Insurance Fund has been significantly intensified.
On the other hand, due to the high insurance threshold and many restrictions, the current coverage rate is still insufficient. According to the "2019 Insurance Industry Operations Table" released by China Banking and Insurance Regulatory Commission , health insurance compensation expenditure is 235.1 billion yuan, accounting for only 6% of the entire medical expenditure structure.
Figure 1 Medical expenditure structure in 2019 (billion yuan)
The improvement of health management awareness, the intensification of population aging, and the medical expenses problems of the elderly brought about by the pressure of medical insurance funds have greatly stoked the demand for medical and health insurance. The emergence of the universal welfare insurance has just made up for the compensation gap of basic medical insurance and alleviated the pressure on medical insurance funds.
1.1 The flaws do not conceal the merits
Compared with commercial insurance products, the low threshold, high security and wide coverage advantages of welfare insurance are actually obvious. The Huimin Insurance products under the "One City, One Policy" of mostly implement a unified price for all insured persons. Products in various places only float between dozens and hundreds. Compared with commercial insurance such as "million medical care", the price is cheap; it is not limited to age, occupation, household registration, and health status, and previous symptoms can also be compensated, which reflects its strong public welfare nature, making the promotion of Huimin Insurance a wide coverage of insurance education popularization; in addition, as a bridge between medical insurance and business newspapers, Huimin Insurance's protection scope supplements many vacancies in medical insurance, and some products meet the medical insurance needs outside the national medical insurance catalog, and high medical expenses such as proton heavy ions, CAR-T, and imported drugs are also supported for reimbursement.
1.2 There are advantages and disadvantages
On the other hand, it has to be admitted that it is difficult to achieve perfection for a product with a maximum of more than 100 yuan. Huimin Insurance also has shortcomings such as high deductible amount, low compensation ratio, unsatisfactory stability in renewal, and relatively few types of special medicines. Taking "Shanghuibao" as an example, its self-service deductible is 20,000 yuan, which is really not easy to achieve. For example, for minor surgeries such as appendicitis and hernia, it only costs thousands of yuan to include medical insurance. In essence, "Shanghai Huibao" is targeted at people with serious illnesses.
In addition, the official has no specific statement on Huimin Insurance "What should I do if I renew my insurance in the second year?" Due to the universal nature of Huimin Insurance, policies in places such as Shenzhen, , Jinhua and other places clearly point out that Huimin Insurance must operate in a way that guarantees the capital and small profits. Higher publicity and operation costs and low premiums make it difficult for underwriting companies to maintain the break-even point.
comparison terms show that compared with the 83 special drugs of a certain internet celebrity million medical insurance, the 21 types of "Shanghuibao" are still relatively few, and value-added projects such as health services have not yet fully covered the needs of insured persons before, during and after diagnosis, and residents' service experience and sense of gain are generally low.
2.0 Focus on product sustainability issues
While Huiminbao is making rapid progress, Huiminbao may face losses. Taking the one-year report card of Shanghai Huibao as an example, the number of Shanghai Huhuibao in the first year launched in 2021 was as high as 7.39 million, and the premium income was about 850 million yuan. Except for the last four months that were greatly affected by the epidemic, during the last 8 months of operation, the cumulative claim amount of Shanghai Huibao was as high as 524 million yuan, accounting for 62% of the total premium income; Shenzhen Critical Illness Supplementary Insurance has continued to increase in the past five years, although the total premium income of the product has been increasing, its total compensation has also gradually increased, and the total compensation amount is generally higher than the premium income. In addition to raising the premium from 20 yuan to 29 yuan from 2017 to 2018, alleviating some compensation pressure, the compensation rate of in other years is higher than 100%.
The unstable factors that restrict the sustainability of welfare insurance are hidden in its product positioning. is first of all, age deviation, and whether it can attract young people to take out insurance is a special consideration for Huimin Insurance. If young people are not willing to participate in insurance and the proportion of people over 40 years old is too large, it will lead to a high probability of disease risk in the entire insured population; secondly, the issue of reverse selection. The number of insured population is an important factor in whether Huimin Insurance can form an effective risk dispersal mechanism. Judging from the price of Huimin Insurance and the characteristics of unlimited population, patients with previous symptoms account for . The ratio will be relatively large, while the insurance awareness of healthy bodies is relatively low, which leads to the amount of compensation paid by the entire plate gradually increasing, resulting in greater operating risks; in terms of pricing, when the insurance rate is high enough to share the medical costs of people with previous symptoms, the logic of "Huimin Insurance" low-income premium high leverage can be established. When faced with the situation where the risk of illness of the entire insured population is high, as a commercial behavior, the pricing of premiums needs to be raised, but the higher the price, the generality of Huimin Insurance will gradually be diluted.
It is not difficult to see that although insurance companies and third-party companies both strategically take benefit-to-people insurance as the entrance, extending to more people and scenarios to help other businesses develop, they still face many pain points and difficulties in the actual operation process. After intensive outbreak and strong coverage, what will Huiminbao go in the future?
In the past, Huiminbao once quickly covered many places across the country with the endorsement of local governments support, becoming a phenomenon-level product and was very popular. After experiencing explosive growth, this type of new inclusive health insurance is gradually shifting from the market expansion period to the platform period. Where will the subsequent development momentum come from? Will it become a flash in the pan? The author believes that Huiminbao wants to maintain a good start in the future, and both increase revenue and reduce expenditure are indispensable.
An important indicator that affects the compensation rate is the number of insured persons. The more people join, the larger the base, and the more funds you receive, the less likely you are to be compensated.So how to market and acquire customers and increase the base? First of all, it is service. It can be seen that local welfare insurance companies have recently been deeply integrated with full-cycle medical and health services to meet customers' health management needs at different health stages to enhance the sense of gain of insured residents. A more typical case is on August 17, 2022, Fujian Huiminbao and third-party institutions officially launched the Kangfu Health and Huiminbao service card, providing insured residents with 10 major health services including health management, medical assistance, and drug purchase benefits, aiming to improve the satisfaction and happiness of insured residents.
Figure 2 Huiminbao Health Service Card Introduction
At the same time, from the perspective of payment opening, Huimin Insurance needs to strive for government participation, open up medical insurance accounts, seek stable payers, and improve the protection awareness of the people through professional urban marketing strategies and improve the insurance participation rate. It is worth noting that not long ago, against the background of adjustments in Beijing's medical insurance policies, the " Beijing Inclusive Health Insurance " product has also been upgraded accordingly, supporting the use of the medical insurance account balance to purchase welfare insurance products for myself and my immediate family members.
In terms of strengthening payment sustainability, , on the one hand, we must design self-paid protection responsibilities, define the scope of compensation, form a reimbursement catalog, and explore integrating innovative payment models with medical, pharmaceutical and other fields in the health industry to reduce compensation costs; on the other hand, we must realize data interconnection and interconnection between multiple entities such as the Medical Insurance Bureau, regulatory agencies, and insurance institutions, and improve innovation and precise pricing of welfare insurance products.
Conclusion
The development of universal medical insurance products is itself reducing the burden and exploring the way forward for basic medical insurance . As an innovative insurance product that benefits the country and the people, everyone hopes that it can develop and evolve for a long time, and provide timely help to families who are hesitating to poverty due to illness. But only business behaviors that do not lose money can be sustained. The author believes that the welfare products must first clarify their positioning and clarify whether they should follow the government-guided universal welfare path and let the government pay for it? Or follow the commercial profit model led by the Insurance Department and conduct small profit-making operations? In order to adhere to the universality of welfare insurance, the government needs to continue to track and observe the chemical reactions generated after the combination of universal medical insurance products and local basic medical insurance systems, and promptly support whether the National Health Insurance Administration will intervene and how to intervene in the institutional decisions of universal medical insurance, so as to guide the healthy development of welfare insurance.
sincerely hopes that Huiminbao can overcome all obstacles, move forward steadily, and contribute long-term value and strength to our country's big health and people's livelihood project.
