“For less than 20 cents a day, the maximum reimbursement is 1 million yuan”.
Today, under the guidance of Kunming Medical Security Bureau, the “Chuncheng Huimin insurance” jointly underwritten by many insurance companies has attracted many consumers’ praise. According to the product design of “Chuncheng Huimin insurance”, consumers only need to pay a premium of 69 yuan a year. On average, they can get up to 1 million yuan of insurance compensation for less than 20 cents a day.
“Huimin insurance” is a kind of urban customized medical insurance. As the insurance threshold is low, the price is close to the people and the scope of protection is wide, it can effectively cover most of the medical expenditure burden above Lbx Pharmacy Chain Joint Stock Company(603883) basic medical insurance. Lbx Pharmacy Chain Joint Stock Company(603883) and market people call this medical insurance “Huimin insurance”.
With the support of local medical insurance bureaus, bancassurance bureaus, financial bureaus and other government departments, in 2021, “Huimin insurance” was popular in 27 provinces and more than 200 prefecture level cities across the country, with a total of 140 million people insured. During the national two sessions this year, “huiminbao” also triggered a heated discussion among the representatives and members, and many representatives and members put forward suggestions on the future sustainable development of “huiminbao”.
The reporter found that the representatives and committee members mainly focused on two topics: first, they hoped that “Huimin insurance” would include more rare diseases into the coverage, share more high medical expenses for Lbx Pharmacy Chain Joint Stock Company(603883) and alleviate the problem of high medical expenses that Lbx Pharmacy Chain Joint Stock Company(603883) may face, similar to the problem faced by the owner of the film “I am not a god of medicine”; Second, in view of the adverse selection risk faced in the development of “benefiting the people and protecting the environment”, suggestions are made on exploring the path of sustainable development.
expand the scope of protection and “protect” rare diseases and special drugs
On February 17 this year, Mr. Zhao in Beijing received 1 million yuan of “Huimin insurance” compensation. He is the first insurance consumer to obtain car-t cell immunotherapy compensation through “Huimin insurance”. It is understood that car-t cell immunotherapy can give cancer patients more treatment options, which is commonly known as “anti-cancer magic medicine”. However, car-t cell immunotherapy is expensive and is not covered by medical insurance reimbursement. The cost of up to 1.2 million yuan is unbearable for many patient families.
“Huimin insurance is an institutional innovation for commercial insurance to participate in the multi-level medical insurance system. It is a bold exploration to hedge the medical inflation rate of 10.7% and share the burden of high medical expenses for low-income groups. It is an important practice to promote common prosperity.” Zheng Bingwen, member of the CPPCC National Committee and director of the world social security research center of the Chinese Academy of Social Sciences, said.
Ding Jie, member of the National Committee of the Chinese people’s Political Consultative Conference, former vice president of the first hospital of Peking University and chairman of the rare diseases branch of Beijing Medical Association, said that from the existing data, it can be seen that the number of “Huimin insurance” covering high-value drugs for rare diseases outside the medical insurance catalogue is still small. Local “Huimin insurance” products covering high-value drugs for rare diseases are different in terms of variety and quantity of drugs, insurance liability and claim settlement limit, which is far from meeting the needs of drug expenses of patients with rare diseases.
She suggested that high-value drugs for rare diseases be included in the protection scope of “benefiting the people”. “Huimin insurance” is positioned as the supplementary payment for major diseases outside the basic medical insurance catalogue. At present, when high-value rare disease drugs fail to enter the medical insurance drug catalogue, we should actively explore the guarantee scope of “Huimin insurance” for high-value rare disease drugs to enter all regions.
Zhang Huilin, the director of the National People’s Congress, also proposed to promote the “new business management mode” of Hunan Huilin Medical Insurance Institute and promote the “joint venture management mode” of the National People’s Congress and the people’s Insurance Institute.
attach importance to adverse selection risk and explore the path of sustainable development
Yesterday, Chongqing Huimin Insurance – “Chongqing yukuai insurance” announced that the product has been in effect for 66 days, the compensation amount has exceeded 100 million yuan, and more than 30000 insurance consumers have participated in the settlement of claims.
A long-term observer of “Huimin insurance” said that in November last year, the claims of “Huimin insurance” and “huhuibao” in Shanghai surged in a single month, which aroused widespread concern in the society. To some extent, these phenomena indicate that many consumers may be insured for “benefiting the people” with diseases, which means that there is a large adverse selection risk in the operation of the product. In the long run, its operation and sustainability may be affected.
Sun Jie, member of the National Committee of the Chinese people’s Political Consultative Conference and researcher of the National Institute of opening up of the University of foreign economic relations and trade, said that due to the low price, “Huimin insurance” usually sets a high deductible, which makes it difficult for young healthy people to get compensation for minor diseases and disasters after participating in the insurance, which reduces the motivation to renew the insurance. On the contrary, patients with diseases will actively renew the insurance. Thus, the product may face the risk of “death spiral”, and the loss ratio is rising. At the same time, the local governments in some cities have high requirements for the compensation rate and guarantee responsibility, and lack of compensation for the risk of excess compensation of insurance companies, which makes the underwriting insurance companies face the risk of loss and reduce their enthusiasm for long-term operation.
In this regard, Sun Jie put forward three suggestions: first, improve the relevant systems and mechanisms of “benefiting the people” including strengthening the top-level design, clarifying the qualification standards of business participants, improving the access and exit mechanism, profit and loss balance subsidy mechanism, cross regional service and settlement mechanism, performance evaluation mechanism, etc., so as to ensure the long-term sustainable operation of the “benefit the people and protect the people” project.
second, build a data information sharing platform in accordance with the principles of ensuring user privacy, minimizing availability and data desensitization, open up the information exchange channel between traditional medical institutions, basic medical insurance and commercial insurance institutions, promote the data sharing between medical insurance and commercial insurance, and provide data support for the accurate pricing and successive evolution of “Huimin insurance” products.
third, promote the development of “benefiting the people” business in the central and western regions establish diversified financing channels to form a wide range of premium sources through personal payment, enterprise support, government subsidies and other ways; Guide insurance institutions to develop targeted products for residents in economically underdeveloped areas; Insurance institutions are encouraged to explore the development path of cross regional integration, realize a wider range of risk sharing, and improve risk management and service levels.
Zheng Bingwen also pointed out that the “Huimin insurance” has some problems, such as imperfect information disclosure and large difference in compensation rates among regions. He suggested that the national medical insurance bureau issue relevant policies to support the development of “benefiting the people and ensuring social security”; It is suggested that the National Medical Insurance Bureau allow and encourage all localities to use employees’ medical insurance personal accounts to pay premiums; It is also suggested to establish an industry self-discipline organization and formulate industry standards for “benefiting the people”.
Zhang Lin, deputy to the National People’s Congress, Professor of the school of Finance and statistics of Hunan University and director of the Institute of risk management and actuarial insurance, believes that at present, there are many departments within insurance companies that take the lead in the implementation of “Huimin insurance” business in various regions. Insurance companies lack unified management in terms of information security, Internet compliance and business settlement, and the management of products and compliance is relatively chaotic.
In this regard, she put forward five suggestions: the CBRC issued regulatory rules to standardize the “Huimin insurance” business from two aspects of product design and sales management; Establish the information disclosure mechanism of “benefiting the people and protecting the public”; Encourage independent third-party platforms to collect data and strengthen the security protection of user data of insurance companies; The medical insurance bureau has issued policies to exempt the insurance industry from the interface fees arising from medical insurance data verification and individual account query; Considering the diversified financing channels, it is suggested that the people’s Bank of China support the exemption of payment channel fees for “Huimin insurance” business.
