Research On The Sustainability Of Urban Customized Commercial Medical Insurance Operation

Because the basic medical insurance can only cover basic medical insurance,the coverage of serious illness medical insurance is limited,the premium of commercial critical illness insurance is high,and there are many insurance restrictions,the existing medical security system cannot effectively alleviate the risk of "poverty due to illness" of families with high medical expenses.At present,under the condition of limited government financial resources,it is necessary to bring commercial insurance institutions into the main body of medical service supply,and combine the resources,information,activities and capabilities of commercial insurance institutions to effectively solve the problem of cross-border medical and health services.As a commercial health insurance led by the government and undertaken by commercial insurance companies,City-customized Medical Insurance can effectively fill the gap between statutory health insurance and traditional commercial health insurance with the characteristics of "low premium,high coverage and wide threshold",and become an important breakthrough for commercial health insurance to participate in the construction of multi-level medical security system in China and improve the level of medical insurance.However,the City-customized Medical Insurance market is in the initial start-up stage,the market is developing rapidly and blindly,and the sustainability of its follow-up market is inevitable.Whether its operation is sustainable is not only related to the breadth of social medical security system,but also to the depth of commercial insurance’s participation in social medical security.With the methods of case analysis,comparative analysis and data analysis,this paper reviews the development history,business model,products and accumulated financial management experience of City-customized Medical Insurance,and on this basis,selects the products of City-customized Medical Insurance in Shenzhen,Chengdu and Shanghai as representative cities for case study and comparative analysis.The case study found that the sustainability of the operation of City-customized Medical Insurance faced some difficulties,such as insurance participation rate-death spiral and financial sustainability,inclusiveness-difficulty in improving payout ratio and security level,credibility-trust crisis and difficulty in improving management services.It is found that the main factors that affect its business sustainability are:risk control of medical expenses,actual security level and pricing mechanism,etc.According to the research results,this paper suggests optimizing the top-level design,defining the guarantee boundary of City-customized Medical Insurance,establishing the dynamic adjustment mechanism of City-customized Medical Insurance through technological empowerment,and strengthening industry supervision to standardize the insurance market order,so as to promote the sustainable operation of City-customized Medical Insurance.