State Council General Office on critical illness insurance for urban and rural residents

Source: en.nhfpc.gov.cn

Updated: 2015-08-07

In addition, risks should reflect the discrepancy between expected costs and practical results, with a balance in the medical insurance interests and commercial insurance interests. The GO makes it clear that surplus profits of commercial insurance beyond the contract costs should be returned to the medical insurance fund for urban and rural people. If the commercial insurance companies suffer a loss as a result of adjusted policies on basic medical insurance, the fund will share the loss s a sign of the fairness in government services.

Fourth, the GO asks the parties involved to increase policy support for the commercial insurance business and to cut their costs in critical illness insurance, and makes it clear that income from the critical illness insurance premium must be exempt from business tax or insurance supervision fees. There will be free insurance security money coming in the 2015-2018 period.

Fifth, the GO emphasizes the need to standardize medical services because the critical illness insurance system largely depends on the reasonable control of medical costs. It states that health and family planning departments need to better supervise medical institutions and medical service quality. Commercial insurance companies need to work closely with human resources and social security, and health and family planning departments on medical payment reforms. And there needs to be a clinical plan formulated as soon as possible, with better diagnosis and treatment standards, more standardized medical treatments, and medical costs kept in line. Critical illness insurance should be based on better medical services, medical security reforms, and centralized drug procurement. Better supervision of diagnosis and treatment technology and medical services can put a stop to medical risks and unreasonable expense, and is a fundamental way to guarantee long-term, stable development of critical illness insurance. It is only by forging a link between medical treatments, insurance and medicines that we can maximize the social benefits of serious illness insurance.

Zhu Minglai, professor, Nankai University Health Economics and Medical Insurance Center