| In the21st century, our country’s commercial health insurance business has experienced rapid development. The premiums of health insurance have increased18times in the last13years. By the end of2013, the premiums exceeded100billion Yuan. Meanwhile, China’s health insurance density continues to improve, the consumption of health insurance per person increased from29Yuan in2006to83Yuan, an increase of300%. From the increase of insurance density we can find out the improvement of the awareness of health security. According to relevant statistics of Chinese50large and medium cities, the proportion of people who are in need of health insurance is up to77%. The rapid growth of economy, high medical costs and the spread of health awareness directly or indirectly increase the people’s attention on health risks. At the same time, in order to promote the rapid growth of health insurance business, the relevant regulatory authorities enacted a series of laws which play important roles in the development of health insurance.While we see the rapid growth of our country’s commercial health insurance, we also should pay attention on the problems which exist in the process of development. From1990to2009, the annual compound growth rate of Chinese medical expenses reached19%, while medical expenses increased from25.7Yuan to856.4Yuan, an increase of nearly34times. Enormous risks are hiding behind the quick growth of medical expenses. Especially the high incidence of cancer, cardiovascular disease today, poverty caused by illness is nothing new now. Meanwhile, medical resources are also short of supply. The number of doctors per thousand is only14; while22beds per million, ranked one hundred away in the world. Scarce health resources have led to low medical quality, rent-seeking behaviors and high costs of treatment. Low efficiency of settling claims, high costs of claims and the difficulty of risk control are the problems perplex the commercial health insurance companies. These issues come from health insurance companies’extensive business model and the weak position compared to hospital fundamentally. First, the risk of health is usually covered as an accessory risk of life insurance, and share the marketing channel of life insurance. In this mode, the direct result is poor services of claim and health insurance’s low contribution in life insurance. In addition, the weak position of commercial health insurance companies and poor client resources give birth to moral hazard. Therefore, building a healthy industrial chain can improve commercial health insurance companies’operating.This article starts from the present situation of commercial health insurance in China. Then we compare with American managed care in the extension of industry chain of health insurance. From the comparison we can find out the shortages in the development of our country’s health insurance. Then, we put our focus on the content which not mentioned above. We use game theory to analyze the divarication of interest. At last, we put forward some useful advices.The introductory chapter mainly focuses on the background, the purpose and significance of this research. Besides, this chapter discusses the research status, and the innovation of this paper.The structure of the remains is divided into five parts, the followings briefly give you an overview of the structure:The first part provides an overview of the development of Chinese health insurance industrial chain. This part is introduced in four aspects. They are scale of health insurance market, models of health insurance companies’operating, technical merit of industry chain and policy environment. We will analyze the root of the problems with relevant industry data.The second part introduces American experiences of extending industry chain. Based on the overview of American health insurance industry, we analyze its experiences. At last, we put forward some advices by comparison.The third part uses game theory to analyze the problems appeared in the industry chain of health insurance. We put our focus on the dishonest behavior of doctor-patient, the problems in insurance company’s supervision.The fourth part analyzes the relationship between insurance company and other participants based on game theory. We use the results from the models of game theory which associated with the reality to put forward some useful advices.The fifth part is the advices of building our country’s health insurance industry chain. This part is the key section of this paper. Firstly we introduce the relationship between insurance companies and other participants of the chain. Then we propose the way to improve personnel training, information systems and policy environments. Finally, this paper introduces some unique characteristics in the contract of industrial chain.In this paper, I analyze American managed care systematically. But the limitations of data acquisition make some places seem unpersuasive. Compared with previous papers, this paper has some innovations:I used game theory to analyze the relationships between the subjects of the industry chain. Then I discuss the American managed care in a systematic way, which would be useful and helpful to future studies. |
