** Monopoly over agency will break

At present, the relevant government departments are pushing the "three medical" linkage measures, or will allow the introduction of commercial insurance company model to break the monopoly of medical insurance agencies.

The executive meeting of the State Council held on March 25 emphasized that China will continue to increase investment, pay attention to the role of the market, and implement the three linkages of medical care, medical insurance, and medicine. This month, the National Development and Reform Commission loosened the price management of private hospitals as follows. It mentioned “the establishment of a negotiation mechanism for medical insurance agencies and designated non-public medical institutions.”

However, at present, in most parts of China, the real negotiation mechanism between hospitals and medical insurance agencies has not yet been established. Some industry insiders believe that the reason is that medical insurance agencies have always been in a highly monopolistic state.

According to Jiang Shan, senior researcher of the Public Policy Research Department of the China Economic System Reform Research Institute, this high degree of monopoly is mainly manifested in three aspects: First, the medical insurance service management office has no distinction, and the handling agency and the competent human agency have the same special “father and son”. Relationships; Second, in each medical insurance coordination area, there is only one handling agency sent by the competent authorities, and the participants do not have room to choose the second handling agency; third, the handling agency and the designated medical institution should be equal. Agreement, but the reality is that the relationship between the two has completely become supervised and supervised.

“A monopolistic situation of medical insurance contractors has led to the lack of bargaining chips for medical institutions and cannot implement linkages.” Chen Yong, executive president of Beijing Chaoyang Hospital, pointed out at the high-level forum for public hospital reforms.

An example of the head of a public hospital said: "As soon as the end of the year, the hospital department director orders - the amount of medical insurance funds run out quickly, only a certain number of patients, other medical insurance patients were pushed to other hospitals. "He said:" In fact, our hospital has a high level of medical care in the region, but it does not have the ability to negotiate with the Medicare agency. It is the family that has the final say."

Guo Yue, president of Shanghai Renji Medical Group, also admitted that “Currently, Medicare does not play a joint role with the hospital. Public hospitals cannot negotiate with Medicare. Even weak private hospitals are not even mentioned.” Therefore, he is not optimistic about the NDRC's documents. Cai Jiangnan, director of the Center for Health Management and Policy at the China Europe International Business School, believes that on the one hand, medical insurance funds face the pressure of the collapse of the fund in the long run. On the other hand, the medical insurance department also needs to make the hospital receive reasonable compensation and can not push patients to get patients. Suitable treatment. To effectively solve these problems and contradictions, it is necessary to establish a negotiation and consultation mechanism between the medical insurance department and medical institutions. Guo Qiyong, president of Shengjing Hospital of China Medical University, suggested that commercial insurance agencies should participate in the management of basic medical insurance and increase competition.

Although there is no insurance company in the world handling basic medical insurance, there are precedents for commercial insurance companies to get involved in basic medical insurance management in China.

In April 2012, after the Ministry of Health and other four departments jointly issued the "Guiding Opinions on the Participation of Commercial Insurance Institutions in New Rural Cooperative Medical Care Delivery Services," a number of companies including PICC, China Life, and Pacific Life Insurance participated in the NRCMS Office. , And quickly occupy a place in the overall business of the new rural cooperative medical system. According to the China Insurance Regulatory Commission statistics, in 2013, the insurance industry participated in the management of the new rural cooperative medical service covering 40 million people, entrusted management funds of 6.7 billion, premium income of 250 million, compensation and compensation of 38 million, compensation and compensation of 6 billion yuan.

The relevant person in charge of the Insurance Supervision Department of China Insurance Regulatory Commission stated that the involvement of commercial insurance companies has strengthened the government's supervisory functions and overcame the shortcomings such as insufficient manpower, falsification, and abuse of power. Of course, it has an advantage in controlling inappropriate medical expenditures and has increased its control over inappropriate medical practices. ”

Cai Jiangnan stated that “If there are two medical insurance agencies in the same area, this creates competition. If the medical insurance agency is unreasonable, the hospital can sign another contracting agency. The free choice of medical insurance patients will It forced the medical insurance agency to sign contracts with more medical institutions. Under the premise of full competition, the medical insurance agency has sufficient incentive to negotiate with the hospital.”

However, an expert in the insurance field pointed out that a medical insurance coordination area theoretically only signs contracts with an insurance company. The “two or three competing formats” envisaged by the president of the public hospital are unlikely to occur.

Despite this, some analysts still believe that the NDRC's documents have released a signal that the solution to public hospitals' negotiating mechanism is difficult to solve. From the perspective of private hospitals, “the medical and health field cannot be fully borne by the government, but the government cannot completely disregard it. Can not be fully handed over to the market. To effectively divide the field, link, let the market play a role.

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