Problems And Countermeasures Of Undertaking Serious Illness Insurance By Commercial Insurance Company

With the further development of social productive forces and the improvement of people’s living standard,social insurance plays a more and more important role in national life.Serious illness insurance bear an extremely important social security function,through the reimbursement of major diseases,the economic burden of patients with major diseases has been greatly reduced.In recent years,urban and rural residents serious illness insurance is to gradually enter the market mechanism to the social security system,and to get a very satisfactory result,at the same time,there has been a lot of progress in the basic policy,which is representative of the proportion of compensation,financing,cost management,settlement management and so on.However,in the course of practice,serious illness insurance still has to face all kinds of tests.There are many problems in the policies and regulations,financing level,political and business system docking,cooperation model,hidden price competition and so on when commercial insurance companies undertake serious illness insurance.In addition,the effective convergence illness insurance between public expenditure and commercial insurance companies still have some problems,which is particularly evident in the fact that public finance payments are interfaced with commercial insurers.This paper hopes to solve these problems,and to straighten out the key problems while commercial insurance companies undertaking serious illness insurance.At first,this article takes the commercial insurance company of the operator status as the angle of view,adopts the research methods such as literature analysis method,comparative analysis method and so on.By understanding the typical model,the author clearly analyzes the real situation when commercial insurance companies undertake serious illness insurance.And this paper analyzes the problems existing in the process of undertaking serious illness insurance in our country from three aspects: policies andregulations are not perfect,such as the relevant laws and regulations are not perfect,the government oversight offside phenomenon occurred,medical insurance policy lack of holistic design;policies and regulations are not perfect,such as such as hospital "over-medical",supervision and management,single medical information,lack of sharing of medical information,"smart audit" application level to be enhanced,lack of medical insurance expenditure performance evaluation,lack of quantitative analysis of medical insurance;serious illness insurance features,mechanisms,lacking of standard inquiry lead to a lower level of serious medical insurance.At last,some countermeasures and suggestions are put forward for the problems that arise.Not only from the government’s policy level,with the needs of diverse interests,rationally and scientifically construct the overall legal framework;but also innovative ideas,strengthen the supervision and examination of the participants,strengthen the supervision of the hospital "over-medical",promote the use of "intelligent audit" information means,introduce third-party institutions to assess the effectiveness of health insurance.At the same time,with the promotion of serious illness insurance and in-depth study,comprehensive policy,improve the level of serious illness insurance to strengthen the analysis of the characteristics of serious illness insurance,establish a working mechanism of commercial insurance and social insurance linkage,develop a unified standard of serious illness insurance.