Health Management and Health Insurance (I)
The concept of health management in health insurance
In the health insurance industry, the concept of health management is slightly different from that in the medical industry and can be defined as health guidance and clinical intervention management activities undertaken by insurance management and operating institutions in the process of providing medical service protection and reimbursement to insured persons, using medical services resources or in cooperation with medical and health care providers.
The purpose of applying health management in the health insurance industry is mainly to provide health management services and control the risk of diagnosis and treatment, which can be divided into two categories, as follows:
(1) Health guidance category: mainly includes health guidance activities that are not directly related to diagnosis and treatment, but are related to other health behaviors, with preventive medicine as the main technology, to reduce the risk of compensation by reducing the incidence of disease. More convenient disease prevention health care and care services, such as health check-ups, health assessments, health guidance, etc., are achieved through personalized health and consultation information, as well as individualized health promotion programs.
(2) Medical intervention: mainly refers to the activities of advising and managing the service selection, service mode and service process when the insured person enjoys the medical treatment service in the medical institution. It can reduce the unreasonable medical expenses of the medical treatment process by guiding the medical treatment behavior of the insured person. Specifically through the provision of convenient, timely and reasonable access to the green channel, as well as the provision of expert letters, medical treatment and other full-course medical management to meet the needs of the insured personnel.
Health insurance needs for health management
Health insurance is a financial services industry with health risk as its core content, while health management has the dual functionof of health service and risk management, so the demand for health insurance is reflected in these two aspects:
(1) Health insurance demand for health management services
Health insurance as a financial services industry, in addition to the insurance contract agreed on the cost protection services content, that is, other insurance industry usually for the insured personnel to provide insurance, claims, preservation and other general services, because of the particularity of health insurance business, its service connotation has been gradually extended to the insured personnel closely related, highly specialized medical, preventive, health care and other services. On the other hand, due to the current domestic medical service system is not perfect and the lack of health promotion means and methods, the insured personnel in the purchase of health insurance products, its internal needs are far beyond the scope of cost protection needs, often hope to be able to build through the medical service network and health service platform, access to better preventive health care and medical services.
(2) Risk management needs of health insurance for health management
The risk management ability of health management can not only enrich the existing means of risk control before and after the event, improve its technical content and technical level, but also effectively intervene in the medical treatment and treatment of the insured personnel through the construction of medical network service platform and the provision of medical care services. Health management combines cost security with health services, mainly in the following aspects: (1) by preventing the occurrence of disease, delaying the development of disease, reducing the incidence of disease, to a certain extent, reduce the incidence of insurance accidents; It can also effectively avoid the generation of moral hazard.
The concept of health management in health insurance
(1) Health insurance promotes the integration and development of resources in health management
The insurance industry has a strong management ability of social management and capital, the market-oriented mechanism is strong, with its gradual participation in the field of medical insurance services, will have the ability to integrate and coordinate various types of health care services, for the insured personnel to provide convenient and efficient full service. In addition, the health insurance industry can also use the market-oriented mechanism to promote the rational allocation of medical resources and the healthy development of the payment system through incentive mechanism and customer resources at its disposal. Moreover, health insurance has opened up an application platform for health management, where various new health management technologies can be promoted and become more mature and perfect.
(2) Health insurance is conducive to the popularization and promotion of health management
The right to health is the basic right of citizens, the state from the system to ensure the universality of health insurance, second, health insurance itself has a relatively strong demand for health management, and health management services have a hightechnical content, in the promotion of the road is also more suitable for the use of insurance agents sales. Health management as a new thing if only by the development of alone, to occupy the market and then be accepted by the market will be a long and difficult process. If health management can integrate with health insurance, health management services and products can be successfully promoted through a wide range of well-established health insurance channels.
(3) Health insurance can supervise and evaluate the mature development of the health management industry
In the process of the mature development of health management, supervision and evaluation from all fields inside and outside the industry are required. Health insurance as the most important purchaser and application of health management services and health management technology, on the one hand, its mature market sales experience will promote the establishment of quality standards of health management services, on the other hand, as a financial service institution selling health risks, will be the health management of medical costs and health risk control effect of quantitative evaluation, help to speed up the health management industry technology update and development.
(4) Health management is conducive to improving the degree of recognition of health management
After years of development, health insurance on the real health protection of the population and increasingly mature and perfect service system, health insurance in the population has a good social reputation and market impact, market recognition is high. Health management for the general public is still very unfamiliar, if you can combine with health insurance, through the health insurance institutions of positive guidance and publicity, with the help of health insurance social reputation and market influence, can make the masses gradually deepen the health management of the service concept, service processes, management technology, intrinsic value of understanding, improve the market awareness and recognition of health management.
