medical care
The medical service industry in the trillion-dollar market has long attracted the favor of entrepreneurs, capital and industry leaders (the health insurance market is expected to reach trillion in 2020, and the medical service market is expected to reach 10 trillion). 2065438+September 2005, the registered micro-medical group raised funds with $394 million invested by Gao Yan Capital and Goldman Sachs, which set a new high point in Internet medical care and brought the payer into the focus of the industry. Subsequently, the sky-high valuation of Ping An Good Doctor's $500 million Series A financing of $3 billion once again broke the record, and the seeds of insurance payers took root in the closed loop of Internet medical ecology.
The ACO concept on which 20 15 micro-medicine group relies for financing was first put forward by Dr. Elliot Fisher, a professor at Dartmouth Institute of Health Policy and Clinical Practice in the United States in 2006, and was subsequently incorporated into the American health care reform bill. Dartmouth College has become one of the most important designers of American medical system.
In the traditional medical model (fee service), doctors charge high fees for medical services, diagnosis and treatment. Insurance payers reduce the single payment cost through bargaining, and increase the number of services to cope with the charging power of insurance companies, doctors and other service providers, which leads to excessive diagnosis and treatment and forms a vicious circle. ACO model controls the total payment by packaging medical service providers (specialists, family doctors, nurses, etc.). ) and customers with different functions (more than 5,000 insured). On the premise of ensuring the health level of the insured population (measurement and control results), the remaining expenses become profits, which are enjoyed by medical service providers. ACO mode reduces the payment cost of the payer (reducing reimbursement) and the cost of the service provider due to over-diagnosis (less diagnosis &; Treatment), saving unnecessary clinical time for doctors and expanding the capacity of medical services. And turn the saved expenses into profits, which will be better enjoyed by insurance payers and medical service providers.
ACO model shows the difference between the profit model in health care field and that in other fields. First of all, it is an industry in which patients receive hospital doctor services, but the fees are paid by third parties (medical insurance and commercial insurance). According to WHO report 20 13