The Main Problems And Countermeasures Research Of Our Country’s Current Medical Insurance Cooperation

Commercial health insurance in our country recovered since the end of last century, it has made great progress after 30 years development. Not only products are increasing, but also the premium income continue to grow. According to the insurance statistics report of 2015, Chinese health insurance premium income in 2015 reached 241.047 billion yuan, which is up 51.87% from a year earlier. The development speed is very fast, which is the fastest growth in China’s insurance products. However, if the development of China’s commercial health compared with the international level, there are still a large gap and face many prominent problems, such as the existence of adverse selection and moral hazard. Hospital for medical service providers, which is in the hands of the whole medical market on medical expense and control of medical resources. While insurance companies charge a premium in the process of operation, only with the help of a relationship with the hospital to ginseng protect personnel to provide guarantee and risk compensation, and can not involve in the whole process of medical institutions providing health services. Because the two sides points belong to different interest subjects, lack of common interests constraint mechanism, so that the insurance company is in a passive position in the cooperation and even have no voice. Insurance companies and hospitals this unequal relationship, the generation of moral hazard for prescriptions and the insured. In order to obtain the biggest economic benefits and improve the income of the hospital medical service, the hospital may be in violation of the interests of the insurance company, provide patients with drugs outside of the directory or unnecessary inspections on project, this excessive medical behavior will directly lead to the increase of medical expense and finally increase the management risk of insurance company. From the perspective of the insured, due to the existence of the third-party payment and medical market information asymmetry, the insured may be more concerned about whether they obtained reasonable high quality medical service, and the lack of supervision of the consciousness of the medical expense, moreover make lying about being insured and insurance fraud protection, etc. In addition to obtain economic benefits, Insured and the hospital also conspired to grab the insurance company interests.In order to control the rising medical costs, prevent adverse selection and moral hazard, promote the development of commercial health insurance, our country insurance institutions continuous exploration in recent years. In addition to establish specialized health insurance company, and strive to health professional managing road, also actively seek cooperation with medical institutions, through the establishment of quality and efficient health care new platform of cooperation, realize the complementary advantages between the medical services industry and insurance industry, set up between the two sides equal consultation, mutual reciprocity and mutual benefit relations of cooperation. In recent years, our country has promulgated by a series of policies and regulations to promote the public hospital restructuring, encourage and support social capital to participate in medical institutions, all of these insurance companies to invest in the medical institutions to provide policy support. But from the point of the specific conditions of the insurance company practice in our country, whether it is the insurance company through agreements mode or investment in medical institutions are existence question, has failed to really establish a Shared interests, risk-sharing partnership.In this paper, it is quite in the investment of insurance company in our country since the new reform loosening of the medical institutions, at the same time draw lessons from the successful experience of managed care in the United States, in order to improve insurance companies and hospitals of our country existing cooperation pattern and finally explore a more effective health cooperation pattern. Article is divided into the following aspects: First, the article clearly pointed out our country’s health care cooperation necessity and urgency on the development of China’s commercial health insurance status and analysis of the problem. Second, the article summarizes several existing models of health care cooperation and briefly analyzes their feasibility and problems. Then the article introduces the practice China Ping An Insurance Company of cooperation on health care. Through a detailed analysis of its reasons for the failure, the article further sum up the main problems of our health care cooperation now. In addition, the article summarized the inspiration of American managed care insurance model through for promoting our health care cooperation. Finally, in order to achieve co-operation of insurance companies and medical institutions, the article proposes improvement measures and proposals to promote cooperation and development of health care from the government, hospitals and insurance companies in three areas by considering the reality of health care cooperation.