Can insurance companies deploy the big health industry and niche insurance to leverage the market?

Can insurance companies deploy the big health industry and niche insurance to leverage the market?

The insurance market, mainstream life insurance products such as critical illness insurance and accident insurance and property insurance products such as auto insurance and home property insurance are increasingly favored by consumers and occupy an important market position in the core concept of returning to the source of protection. And some innovative insurance types that may be temporarily in a “niche” state, but also have huge market prospects, are still in the stage of growth and expansion, such as dental insurance and pet insurance. This issue of “Insurance Weekly” focuses on the aforementioned two types of insurance, exploring their “little-known” insurance demand value and potential development challenges.

 Once upon a time, health insurance was only a “supporting role” of life insurance, existing as its additional insurance. But around 2012, life insurance encountered Waterloo, and insurance companies began to pay attention to the blue ocean of health insurance. This year, life insurance has transformed and health insurance has emerged. Since then, the growth rate of health insurance has continued to be higher than the industry average. In recent years, under the combined effect of policy support and market demand, the layout of the ” big health” industry has become a new growth point for the industry. Insurance companies have actively developed commercial health insurance and participated in the reform of the medical system.

 So, as a niche dental insurance in the health insurance segment, will it also stage a counterattack? As things stand, it may take time. The development of “dental insurance” in China is still in a tepid state. In addition to the difficulty in controlling medical costs and preventing adverse customer selection, one of the main reasons is the imperfect compensation and guarantee mechanism for medical expenses.

 According to international experience, if insurance companies can enjoy a greater voice in the entire dental industry, not only consumers will become the biggest beneficiaries, but the dental medical system will also be upgraded, which is expected to lead to the optimization of the general medical system.

Commercial insurance should play a bigger role

 Although the number of oral medical institutions and dentists in my country has increased significantly, the improvement of the dental health of Chinese people is not optimistic. According to the “Third National Oral Epidemiological Survey”, the oral prevalence rate of the whole population in my country is as high as 90%, but the treatment rate is only 10%. One of the main reasons is the underutilization of dental services, especially preventive care. If the development of dental insurance can be accelerated, it is likely to help my country make up for the shortcomings of oral hygiene.

 According to the reporter’s understanding, the cost of dental care and treatment is relatively high, and the vast majority of oral patients in my country can only obtain compensation for treatment costs through basic medical insurance (social security) and self-payment methods, and social insurance covers a small range of oral diseases, a few types, and a guaranteed amount. Low. The means of payment is likely to constrain consumers’ willingness to care for and treat dental health.

 Therefore, some experts have called for commercial dental insurance to be a powerful supplement to the basic oral medical insurance, using its flexible and diverse insurance items, professional skills and insurance methods, etc., for the dental treatment items not covered by social insurance, and the expenses paid by individuals on a pro-rata basis. , and even the payment of medical malpractice, according to the wishes of the insured, different insurance contracts are designed for each individual to fill the gap in the current social oral (medical) insurance.

 Throughout the global market, the United States is a country with a relatively high penetration rate of dental insurance, which has reference significance for my country’s commercial insurance to participate in the quality and efficiency of medical services. Data shows that of the 320 million people in the United States, about 200 million have dental insurance. Of those 200 million people, 150 million have commercial dental insurance, and the remaining 50 million are covered by Medicaid. The market size of dental insurance in the United States is about 75 billion US dollars, and there are about 300 companies providing services to varying degrees.

 In fact, in the dental industry, insurance companies can enjoy a greater say. American insurance companies form large-scale medical care by concentrating on the needs of a large number of patients, negotiating prices with medical service providers, and improving the quality of medical care by screening dentists. Consumers are undoubtedly the biggest beneficiaries. Insurers can also control claims and reduce over-medication by monitoring the dentist’s treatment process. This mechanism embodies the essence of the concept of managed care, in which active management of the dental health of the assured is also one of the important contents. For example, by providing free preventive diagnosis and treatment for the insured, encouraging the insured to do a good job in the prevention of dental diseases, effectively reducing the incidence of oral diseases, and then controlling the payment of large diagnosis and treatment expenses, which is a difference between the patient and the insurance company.

The market has promising prospects and there are many explorers

 Although the development of dental insurance in my country is slow, in the past ten years, there have been some attempts by insurance companies for the advanced medical model of “insurance-medical expense control-health management-payment closed-loop”.

 Among them, PICC Health is the earliest “crab eater” in China to introduce the dental managed care model into my country’s dental insurance market. As early as 2010, PICC Health teamed up with oral medical institutions in Beijing and Shanghai to launch the first domestic dental managed medical insurance product “Guardian Dental Medical Insurance” with the main insurance form, starting from prevention and health care, for consumers. Offers a range of dental care, therapeutic health services, and oral malpractice insurance coverage. In this product, the concept of managed care is very clear. By intervening with the dental medical institutions it cooperates with, the company reduces the price of medical services and improves the quality of services, and at the same time provides the insured with the convenience of direct settlement of medical expenses. However, it is a pity that this product “died away” due to the lack of awareness of consumers’ dental health at that time.

 In recent years, the dental insurance market has ushered in more testers. According to incomplete statistics, companies currently operating dental insurance products include Great Wall Life, Taikang Online, Yongan Property & Casualty, Ping An Property & Casualty, Taiping Property & Casualty, etc. From the perspective of the types of insurance products, it involves preventive health care, dental implant insurance, orthodontic insurance, etc. There is also dental insurance specifically for children. The coverage covers roughly four aspects: health care treatment, basic treatment, complex treatment, and accidental dental treatment.

 He Li, head of commodity operations of Huize Health Insurance, told reporters that the insurance premium for dental diseases is slightly lower, while the insurance for dental beauty involves tooth plastic surgery and restoration, and the premium is higher. The needs of young people for wisdom teeth problems and cosmetic restoration of teeth by beauty lovers determine the necessity of this product development orientation.

 The out-of-pocket cost of dental implants in dental cosmetic restoration is quite high. In this regard, Great Wall Life and the top three public China-Japan Friendship Hospitals jointly launched the Internet innovative product “Great Wall Dental Implant Medical Insurance”. The relevant person in charge of Great Wall Life told reporters that this product standardizes the complex medical process of dental implants, and adopts a method customized by an expert team to solve the contradiction between the information asymmetry between patients and medical institutions in the medical process. At the same time, following the “managed care” model in the United States, insurance companies control and influence medical service institutions, and improve the quality and efficiency of medical service processes through network technology and optimized insurance and medical treatment processes. As far as 2018 is concerned, the synergy between customers, hospitals, and insurance companies is undoubtedly evident. According to the company’s backstage statistics, only about 30% of the dental implant insurance sold last year was converted from hospital outpatient services, that is, the company brought the hospital to the hospital. 70% of incremental customers have come.

 When it comes to “insurance + medical care”, the Caesars Group in the United States can be described as a model, and its operating advantages are reflected in disease prevention and control, health management, and reducing medical costs. The “Caesar Model”, which efficiently integrates medical insurance, hospitals, and doctors, reduces consumers’ medical expenses by nearly 20%. To be the “Caesar Model” in the dental field, Taikang Insurance acquired Bybo Dental last year, which has achieved a win-win situation in customer acquisition and will consider launching a long-term dental insurance program in the future.

 How big is the dental insurance market in my country? The relevant person in charge of Great Wall Life calculated with the reporter about the dental implant insurance, “Only speaking about the Sino-Japanese Friendship Hospital, the upper limit of the number of customers that the hospital can accept is about 6,000 implants per year. If the insurance company can give The hospital brings about 3,000 customers, and if the premium for a tooth is calculated at 10,000 yuan, the annual premium is 30 million yuan.

Can grow with managed care

 If dental insurance can try to introduce managed care for a long time, it will play a key role in the upgrading of my country’s entire medical system. But this advanced model may not be fully accepted for the time being, and we can only follow and improve gradually.

 Ning Wei, director of the Department of Risk Management and Insurance at Beijing Technology and Business University, said in an interview with a reporter from the Financial Times that hospitals are scarce resources in my country, and they do not need to go through insurance companies to obtain patient information. Insurance companies are information weak and cannot redistribute medical resources. capacity, and a lower position in the medical value chain than hospitals and patients. The two essences of managed care are to reduce the loss rate and control medical expenses. Insurance companies can neither reduce the loss rate for profit, which is irresponsible to consumers nor can it achieve the ability to control hospital income and patient expenses. , because among the three parties in the mastery of information technology, those with weak information cannot control those with strong information. Therefore, based on the current medical industry chain structure in my country, it is not realistic to simply introduce managed care.

 However, commercial insurance companies provide medical insurance services by acquiring hospitals or opening hospitals; private hospitals try to open up a closed-loop of medical services by establishing health insurance companies, and some insurance companies connect with the social security system, and social security is the first for moral hazard These are all beneficial explorations for managed care and the upgrading of the medical system.

 He Li said that more developed countries implement the family doctor system, and patients will receive the advice of family doctors for regular inspections, and then strictly prevent, treat, and maintain. If the assured is willing to choose a dental family doctor and consult with this doctor, the insurance premium can be reduced to a certain extent by referral by the dental family doctor to a dental specialist only when necessary (hierarchical treatment of dentistry). However, there is no systematic health management mechanism in my country at present, and there is no system or established habit. At this stage, it is still difficult to move towards managed care, and it is impossible to emulate American dental managed care on a large scale.

 The relevant person in charge of Great Wall Life believes that the essence of the managed medical insurance model is desirable to improve my country’s medical insurance system and expand the dental insurance market. The person in charge suggested that a nationwide dental insurance association can be established to promote dental insurance, cultivate market soil, and at the same time promote industry self-discipline so that dental insurance can develop in a healthy and stable direction. In addition, the government can provide support to the dental insurance market and encourage qualified companies to provide dental insurance benefits to employees.

 The large-scale implementation of managed care requires a general practitioner training system and talent pool, which is by no means an overnight achievement. There is a view that dental insurance may be the most suitable breakthrough for the introduction of managed care. The dental field has always been a key development area of ​​​​private hospitals. The number of private dental medical institutions in my country has exceeded that of public dental medical institutions. Highly market-oriented private dental institutions have the willingness and flexibility to meet the requirements of managed care. In addition, due to the small number of specialties in dentistry, it is relatively simple to train dentists.

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