Can social insurance integrate commercial insurance into urban and rural social security problems be solved 2010 April 26, 07:29 China Broadcasting Network, Wang Zhongguang, Beijing, April 26 (Reporter Chai Hua) According to the report of Voice of China News at 7: 02, at the end of each year, I rummaged through the boxes to find invoices and inquired about my own medical insurance types. In order to reimburse the medical insurance expenses paid in the past year, I had to go to various places. The new rural cooperative medical care system is. The dual structure of urban and rural areas still puzzles many people in the medical insurance circle. However, in Zhanjiang City, Guangdong Province, a new urban and rural basic medical system has been quietly running for more than a year. In order to solve the shortage of manpower, financial resources and professionals in the process of full coverage of medical insurance, Zhanjiang Social Security Bureau and China PICC Health Insurance Company have embarked on a new idea of comprehensive integration. In the building of the Social Security Bureau, commercial insurance staff and civil servants of the Social Security Bureau are interspersed on all floors. On the road of exploring the "urban-rural integration" of basic medical insurance, can social insurance and commercial insurance cooperate so closely to solve the coverage problem of economically underdeveloped provinces? Most of the people who come and go through the discharge formalities in Guangdong Agricultural Reclamation Center Hospital are Zhanjiang people who hold medical insurance cards for urban and rural residents. Just now, the old man only paid 1590.3 yuan at his own expense to complete the discharge formalities. The rest of the medical insurance has been prepaid to the hospital through the social security bureau and insurance company at the beginning of the month. This is a small detail of the "Zhanjiang model" in the urban and rural medical insurance reform we are talking about today. For more than a year, this urban and rural medical insurance model has been widely accepted by Zhanjiang people. Old people discharged from hospital: In the past, medical insurance covered a little more than 30%, and now medical insurance covers 45%. As early as July 2007, Zhanjiang Municipal Government and PICC Health Insurance Company began this round of medical insurance reform exploration. Zhanjiang has a population of 7.45 million, of which 4.5 million are agricultural. In such an underdeveloped agricultural province, it is not easy to solve the "urban-rural integration" of medical insurance, and the "Zhanjiang model" is famous for it. Zhao Ping, Vice Mayor of Zhanjiang City: We made use of the professional teams of insurance companies in government management departments, some of their offices and a network to do this. At present, the number of people insured in Zhanjiang is 5.46 million. According to our current organizational setup of 1: 10, at least 600 talents are needed, because you have 600 employees. In order to solve the relative shortage of human and financial resources of the government, Zhanjiang embarked on the road of cooperation with insurance companies. In 2009, Zhanjiang City, Guangdong Province began to implement a new urban and rural basic medical system, realizing unified policies, unified management and unified accounting for residents' basic medical care. Zhanjiang insured residents can see a doctor free of charge in the designated hospital of 175. In addition, the proportion of reimbursement for medical expenses after the reform has been greatly improved on the basis of the original reimbursement system. As a result, in 2009, more than 85% of the city's residents obtained basic and large supplementary medical insurance, and the per capita medical reimbursement in rural areas increased by 12.6% compared with the new rural cooperative medical system, which truly realized the overall medical insurance for urban and rural residents. Zhu Minglai, a professor of insurance at Nankai University, said that the real significance of Zhanjiang model lies in finding a better way to integrate government and enterprises in medical insurance reform. Zhu Minglai: Commercial insurance participates in social insurance. In fact, since the late 1990s, we have been conducting pilot projects in various places. The cooperation between PICC health and social security departments is a relatively in-depth cooperation. For example, they started to cooperate. In the past, we said PICC, and we participated in social security cooperation. Well, let social security charge us an insurance premium, and then we will do supplementary business. This time, in addition to cooperation from the source, it is equivalent to evaluating the management quality of medical services and restricting the supervision of designated hospitals. This part is equivalent to forming a comprehensive management method. In fact, our social security is now under construction, and the coverage of social security is further expanded. If you want to entrust it to a commercial insurance company, you can do great things with small money in these places where our economy is not very developed. I think this effect may be better from the perspective of cost saving. It is understood that in this new medical insurance system, individual contributions have not increased, and only 15% of the funds of individuals and governments at all levels are handed over to insurance companies for purchasing large medical supplementary insurance. However, the reimbursement amount of residents' medical insurance has been increased from 1.5 million yuan paid by the Social Security Bureau to 50,000 yuan and 80,000 yuan now. This extra cost is naturally the obligation of the insurance company, and neither residents nor the government will pay the bill. Liang Tao, Director of Zhanjiang Social Security Bureau: In the past, the reimbursement rate was low and the links were very complicated. He didn't even dare to look when he was ill. The so-called "overall planning now" means that there are 20,000 to 30,000 people in the community, but he can't reflect that there are fewer people in social insurance. He dare not mention too much treatment. Now, after the integration with commercial insurance, we have implemented the city-wide overall planning of five counties, six districts and prefecture-level cities. We have calculated an account, and it is not just ordinary people who are happy behind this distribution. When the reporter came to the hospital for an interview, Zhang, president of Guangdong Agricultural Reclamation Center Hospital, also had his own idea: there are many people in our hospital. In this case, the patient was basically cured when he was hospitalized. When they had no money, they had to retreat. After full coverage, the hospital has changed. First, there are many sources of diseases, and the arrears of patients are also significantly reduced. For example, after the development of medical insurance in recent years, with the social medical insurance fund of 15%, the medical insurance has tripled, and the government, hospitals and patients all laughed. But you have to pay 75% for 15%. I'm afraid I don't trust any businessman who talks about this transaction. Insurance companies are also enterprises, and the logic is not complicated. Zhu Ming, a professor in the insurance department of Nankai University, explained the interest chain behind this: The first one is not to take our compensation as a cost to help the society provide some related social security services, but to establish your corporate image. This effect may sometimes be better than your millions of advertisements. The second concept, our current business with health insurance is not very big, but insurance is a law of large numbers. Using data can fully measure our real health risks in the future, which is actually very beneficial to our future business development. Ye Xiao, secretary of the Party Committee of Zhanjiang Central Branch of PICC Health Insurance Company, said that although the cooperative business does not make money, other businesses have multiplied: the medical policy of medical insurance for urban and rural residents should be covered with our company's LOGO, which is a new biography. With the publicity in urban areas and towns and counties, the company's productivity has been significantly improved. In March of this year, we started a pilot project, and we did cover that major disease within one month. We received 300,000 premiums a month. Zhao Ping, vice mayor of Zhanjiang, said that they will continue to expand more space and support for commercial insurance companies and expand the scope of insurance services. Obviously, Zhanjiang City has succeeded in breaking the division of social security bureau, health bureau and labor security bureau in this way of cooperation. Whether this success can be translated into broader benefits remains to be seen in the next few years. Professor Zhu Minglai, Department of Insurance, Nankai University: In the process of further promotion of this model in the future, I think it is mainly in two aspects. On the one hand, the success of this model is actually due to the local government's recognition of commercial insurance participating in the social security system. In fact, in our new medical reform plan, the central leading comrades have made important instructions on this issue. In the process of further expansion in the future, no matter which province or city you go to, this should be a foundation and must be. The second mechanism is now a pilot project. For some details in the future, let's see if our insurance regulatory authorities and our government can unify some documents and institutionalize some experiences in the process of further expansion of this system. Zhanjiang, Guangdong province explores the comprehensive integration of social insurance and commercial insurance 2010-04-26 08: 08:15 Source: China Radio Network (Beijing), Wang Zhongguang, Beijing, April 26 (Reporter Chai Hua) According to the Voice of China News and Newspaper Summary at 6: 54, Zhanjiang City, Guangdong Province explores the comprehensive integration of social insurance and commercial insurance. In this new medical insurance system, individuals and the government do not pay much, but pay 15% of the medical insurance fund to the insurance company every year. At the same time, the Social Security Bureau and commercial insurance companies are co-located, and commercial insurance is fully involved in management. However, the amount of reimbursement for residents' medical insurance has been greatly increased, and the service is more convenient. Liang Tao, director of Zhanjiang Social Security Bureau, said: "With few people, the law of large numbers in social insurance cannot be reflected. Now, together with commercial insurance, it has realized the overall planning of a prefecture-level city. We have calculated an account and can improve the treatment. " As long as urban and rural residents pay 20 yuan as before, they can enjoy the basic medical insurance with a maximum reimbursement of 50,000 yuan a year, nearly twice as high as before 2008. "This medical insurance used to be a little more than 30%, and now it is 45%." The staff said. Zhanjiang has a population of 7.45 million, of which the agricultural population is 4.5 million. The government is not rich. Since the implementation of the new system in 2009, more than 85% residents in the city have obtained basic and large supplementary medical insurance, and the per capita medical reimbursement in rural areas has increased by 12.6% compared with the new rural cooperative medical system, thus truly realizing the integration of urban and rural medical insurance. Zhu Ming, a professor of insurance at Nankai University, said, "If you want to entrust it to a commercial insurance company, you can do great things with a little money in these underdeveloped areas. I think this effect may be better from the perspective of cost saving. " Suggestions on the development path of social insurance reform and commercial insurance in China 2010178: 35 Source: Insurance Research Author: He Wenjiong.

Related Tags: Commercial Insurance Development

Today's society is a risky society. In this society, all kinds of risks faced by people need to be effectively dealt with. Therefore, how to effectively allocate risk protection resources has become one of the core issues of risk management. Among various means to deal with risks, insurance is a traditional and effective mechanism. There are three types of insurance: mutual cooperation insurance, commercial insurance and social insurance. How should these three types of insurance be divided? How to coordinate development? This is a question of great practical significance. This paper focuses on the relationship between social insurance and commercial insurance and related issues. From the risk of insurance, there are many similarities between personal insurance and personal injury liability insurance in social insurance and commercial insurance. Therefore, the reasonable division of labor and cooperation between commercial insurance and social insurance has always been an important issue of academic research, industry practice and people's concern. This paper holds that social insurance and commercial insurance are two major resources of risk protection services, and should be reasonably combined through effective mechanisms to reduce the risk management cost of the whole society and improve the risk protection level of all members of society. First, the relationship between social insurance and commercial insurance There are three types of insurance in modern society. Judging from the time when they appeared, they were mutual cooperation insurance, commercial insurance and social insurance in turn. Among them, the exact date of birth of mutual insurance and commercial insurance is difficult to verify. It is generally believed that mutual insurance has a history of more than 3,000 years, and the oldest existing commercial insurance contract in the modern sense is 1347+05438 10, which was signed in Genoa, Italy on October 23rd. It can be seen that commercial insurance existed at least at that time. When social insurance was born, the academic circles generally issued behavioral signs with the German sickness insurance law of 1883. It is worth noting that the emergence of three kinds of insurance is closely related to the changes of the times, historical evolution and the progress of human civilization. The emergence of commercial insurance behavior is the product of the development of commodity economy to a certain stage, while the emergence of social insurance system is the result of government intervention in the risk protection service market. Mutual cooperation insurance and commercial insurance are both voluntary behaviors. Economic subjects who face specific risks and have certain ability to pay transfer risks by joining mutual aid organizations or buying insurance, so risk protection service is a market. Under this mechanism, the risk guarantee resources can be optimized to some extent. However, with the changes of the times and risks, this market clearly shows its defects: the poor can't use such means to transfer risks because of their insufficient ability to pay, especially with the process of industrialization and urbanization, the risks of social members increase, the gap between the rich and the poor widens, and the number of social members who have the demand for risk protection but lack the ability to pay increases, which has formed serious social problems. As a result, the government began to intervene in the field of risk protection services. 1883 Germany is the first to introduce the social insurance system, which shows that the government not only provides survival risk protection services for the poor through social assistance, but also provides basic risk protection services for all working-class people. After World War II, developed countries have gradually extended the coverage of social insurance system to all citizens, which means that the government directly provides risk protection services for the basic risks of social members. From an economic point of view, this is the result of government intervention in the risk protection service market, because the risk protection service market with mutual insurance and commercial insurance as the main body failed, and the government intervened through social insurance. In this process, mutual cooperation insurance and commercial insurance with a long history have gradually changed their business scope and service objects-providing various risk protection services other than social insurance for members of society who have the ability to pay. After the 1970s, the economic crisis triggered by the oil crisis triggered the worldwide social insurance system reform. Social insurance funds in many countries are in crisis, so we have to take various measures to control or even reduce social insurance benefits. Its core is to limit and reduce the labor cost of employers and the government's responsibility to social insurance funds. This is what some scholars call "government failure leads to the reform of social insurance system". In this context, the position of commercial insurance in the whole risk protection service system has been re-recognized, and its positioning has become clearer-providing various risk protection services other than social insurance for members who have the ability to pay, and providing supplementary insurance services based on social insurance. After such a process, the academic circle of risk protection has gradually formed such a * * * understanding: based on the basic risks of social members and the responsibility of the government, the main types of social insurance are social endowment insurance, social medical insurance, unemployment insurance, work injury insurance and maternity insurance, which are directly handled by the government, with a certain amount of social insurance premium injected and the responsibility of the fund assumed. It is precisely because social insurance is handled by the government that social equity must be the core value orientation and the basic livelihood of social members must be guaranteed as the goal. This concept is generally accepted by academic circles and political circles, and is embodied in the laws of most countries. Commercial insurance and mutual cooperation insurance are organized by non-governmental organizations (enterprises or non-profit organizations) and belong to market behavior. The former is for profit and the latter is non-profit. In terms of security items and security levels, commercial insurance and mutual assistance and cooperation insurance are set up according to social needs, and members of the society choose voluntarily. When the risks covered by these two types of insurance are the same as those covered by social insurance, social insurance is the basic protection, and the other two types are supplementary protection, that is, social members must participate in social insurance first, and then participate in commercial insurance or mutual cooperation insurance, unless there is no such protection in social insurance. Second, the crowding-out effect of social insurance development on commercial insurance In China, insurance in the modern sense is imported. Commercial insurance began at 1805, and the universal implementation of social insurance system began at 195 1. After 1978, the market-oriented economic system reform was gradually launched, and the economy and society began to transform. The social insurance system, which was originally adapted to the planned economy system, has all kinds of unsuitable symptoms and needs to be reformed urgently. In the past 20 years, China has carried out a series of reforms in the field of social insurance, and successively promulgated and implemented a series of new systems and policies. A new framework of social insurance system that is compatible with the level of economic and social development is taking shape and developing steadily in the direction of covering urban and rural areas and benefiting the whole people. Judging from the past 30 years, China's commercial insurance has developed in the process of recovery. Judging from the relationship with social insurance, commercial insurance once assumed some social insurance responsibilities when the social insurance system was not perfect during the transition period. However, with the development of social insurance, commercial insurance has given way to social insurance in some fields, which makes some insurance workers feel confused. In fact, many measures in the early stage of China's economic system reform were based on reducing the level of workers' risk protection and employees' welfare. In this context, a considerable number of wage earners lack due social insurance, and some even cannot get their wages in full and on time. In this way, some workers and members of society are guaranteed by personal insurance and personal injury liability insurance in commercial insurance, which also creates certain development opportunities for commercial insurance companies. For example, in the 1980s and 1990s, many employers bought supplementary pension insurance, accident insurance and even family property insurance for their employees, and some also bought employer liability insurance. At that time, group insurance business accounted for a large proportion in the total life insurance business of insurance companies. However, with the expansion of social insurance coverage, the group life insurance business of insurance companies is no longer "beautiful", especially in the provinces with rapid and thorough economic transformation, the social insurance work is vigorously promoted, and the group life insurance business is declining faster. In recent 10 years, new basic old-age insurance system for employees, social old-age insurance system for urban and rural residents, basic medical insurance system for employees (hereinafter referred to as "employee medical insurance"), new rural cooperative medical system (hereinafter referred to as "new rural cooperative medical system"), basic medical insurance system for urban residents (hereinafter referred to as "urban medical insurance"), unemployment insurance system, industrial injury insurance system and maternity insurance system have been introduced one after another, and the coverage of social insurance has increased. In fact, under the premise of a certain security demand and ability to pay, the demand for commercial insurance naturally decreases because compulsory social insurance meets part of the security needs of social members. In other words, part of the demand for commercial insurance has been forcibly replaced. In the initial substitution stage, the substitution rate is often higher, that is, less social insurance often replaces more commercial insurance demand. At the same time, the higher the level of social insurance, the stronger the absolute substitution for commercial insurance, so the greater the restriction on commercial insurance. On the contrary, the lower the level of social insurance, the greater the development space of commercial insurance. Third, the development space of commercial insurance brought by the deepening reform of social insurance After a long period of reform and construction, China's social insurance system has formed a new framework system, but there is still room for improvement, which needs deepening reform to achieve. At present, there are three most prominent problems in the field of social insurance in China: one is the lack of fairness, the other is the lack of sustainability, and the third is the low efficiency of system operation. There are two keys to solve these problems: one is to establish the construction idea of multi-level social security system, and the other is to define the responsibility of the government reasonably, so as to determine the appropriate level of security. More than a decade ago, the academic community basically reached a consensus that the principle of social security system reform is "wide coverage, low level and multi-level". In recent years, there has been a new and more complete formulation-full coverage, basic protection, multi-level and sustainable. I think there is another word, which is to change "wide coverage" to "full coverage". The so-called full coverage means that everyone should participate in social insurance for basic risk protection projects. Therefore, to "accelerate the establishment of a social security system covering urban and rural residents", there are two key issues to be clarified: First, which projects cover urban and rural residents? Second, what is its protection level? The so-called basic guarantee is to determine an appropriate level of protection, which should be determined according to the basic needs of social members for risk protection, the responsibility of the government and the financing capacity of society, that is, it is usually said to be compatible with the level of economic and social development. The so-called multi-level means that the social security system consists of two parts: basic security and supplementary security. Social security projects directly organized by the government only provide basic protection for members of society, which is the first level. On this basis, make full use of social forces to develop risk protection, including families, employers, social organizations and various non-governmental organizations, and establish the second and third levels of protection. The so-called sustainability means that all social security systems should be able to run continuously and healthily for a long time. To realize the sustainable operation of social security system, we need: moderate security level+scientific system design+effective management service. Among them, it is very important to determine the appropriate protection level. We believe that only the basic elements can be fully covered; Only by maintaining the basics can it be sustainable; Only by ensuring the basics can we establish a multi-level risk protection system. In modern society, the government has the responsibility to provide basic risk protection services for all members of society. In addition to social assistance and public welfare, the government mainly realizes this responsibility through social insurance. What needs to be emphasized is that the social insurance service provided by the government is only a basic guarantee, not a high-level full guarantee, otherwise it will affect social efficiency and cultivate "lazy people". The demand for risk protection beyond the basic projects and above the basic level of protection should be met with the help of social forces and market mechanisms. At this time, the government's responsibility is to formulate relevant rules, assume regulatory responsibilities, and ensure its standardized, healthy and orderly operation, rather than directly arranging. In addition, it is necessary to clarify the responsibilities of governments at all levels and properly handle the relationship between the central and local governments, the relationship between higher and lower governments and the interests between regions. Based on this understanding, in the coming period, the focus of the reform and construction of the social insurance system and the resulting commercial insurance development space should be in the following aspects: First, the reform of the social old-age security system in institutions and institutions and the development of occupational annuities. From the perspective of social equity, we should reform the retirement security system of government agencies and institutions, reform the basic old-age insurance system for employees, realize the unification of the social old-age insurance system for all working-class people (employees in government agencies, institutions, enterprises and various economic and social organizations), and then create conditions to gradually realize the unification of the basic old-age insurance system for all citizens. In this context, occupational annuities (including enterprise annuities) will have new development space.