Chinese Commercial Health Insurance Regulatory System Research

Health insurance is a type of life insurance to compensate insurant for medical expenses due to illnesses or injuries or to compensate insurant for loss of disability and unemployment due to illnesses or accidents. As an important part of life insurance, compared with life insurance and accident insurance, besides that the insurance liabilities are entirely different, private health insurance has its own unique features in terms of the period of insurance, actuarial, benefits, operational risks and contractual terms. These unique risk features of the health insurance lead to the higher demand for specialized operation. Due to the informational symmetry between insurer and insurant and insurance and the characteristics of the health risks, health insurance market often fail to function. Governmental regulation of the health insurance market mainly aims to prevent such market malfunction so as to protect the interest of insurer and insurant. Therefore, we need to establish a special regulatory rule. In addition, in order to avoid the different regulatory standards led by different insurers, we need to establish a unified regulatory approach.This paper presents the development of China's private health insurance, as well as the problems exist in our private health insurance regulatory system. According to the private health insurance regulatory system in developed countries, this paper tries to construct the framework of private health insurance regulatory system which fits China.By defining the basic meaning of insurance and insurance regulation, this paper analyzes the necessity of the regulation of private health insurance in China. On the basis of expounding the basic theory of insurance regulation, this paper analyzes the insurance regulatory systems of some representative countries and regions in the world. For example, the United States'dual regulatory structure and strict regulation; Canada's special private health insurance laws and regulations; Australia's private health insurance Governing Council. According to the history and current situation of China's insurance regulation, this paper presents the referential significance of the market diversity, operation regularization, technical standard unification and the strictness of the regulatory legal systems of the contemporary Western private health insurance regulatory systems.In view of the issues exist in our insurance regulatory system, this paper explores on the establishment and improvement of China's private health insurance regulatory system. Some recommendations are made in this paper: in the aspects of legal, actuarial, financial and intermediary, to improve our legal system of private health insurance regulation; to establish private health insurance regulatory organizations in China so as to form a completed system of organization regulation, industry self-discipline and society supervision. This paper also introduces the"the principle of health insurance regulation"and puts forward the corresponding countermeasures of the issues existing in it.The main points and innovation of this paper:Due to the own features of private health insurance, that is, it has many similarities with both life insurance and property insurance, on the establishing of private health insurance regulatory system, we need to construct the unique regulatory framework of it by referring to the regulation of both life insurance and property insurance.At present, the domestic private health insurance regulation has not formed a sound system. To build a sound regulatory system of our private health insurance, besides referring to the regulation of life insurance and property insurance, we mainly need to conclude and summarize the regulatory system of developed countries. They are The United States'state regulation and federal regulation, Australia's private health insurance Governing Council and Canada's special private health insurance laws and regulations.This paper's shortage:This paper mainly studies the framework of the private health insurance regulation. As a relatively new subject in China, this paper lacks information and the data mainly come from the literature abroad in English. Due to limited resource and human resource, this paper tries to establish a private health insurance regulatory framework, and as for the detailed research of specific issues, this paper only does some primary works.