Notice on Strengthening the Management of Medical Malpractice Insurance and Medical Accident Insurance
Issued by the Beijing Municipal Health Commission and the Beijing Office of the China Banking and Insurance Regulatory Commission
To:
All district Health and Family Planning Commissions, tertiary hospitals, and relevant insurance institutions in Beijing:
Currently, most public medical institutions in Beijing have purchased Medical Malpractice Insurance (医责险), and some high-risk departments have introduced Medical Accident Insurance (医疗意外险) to mitigate medical disputes and maintain orderly healthcare services. However, issues such as non-compliance and forced insurance sales by certain institutions and insurers have negatively impacted patient experience. To standardize management, protect the rights of both institutions and patients, and align with national policies (including Circular on Strengthening Medical Malpractice Insurance [National Health and Family Planning Commission, 2014] and Guidelines for Advancing Medical Malpractice Insurance [Beijing Municipal Commission, 2016]), the following requirements are hereby issued:
I. Clarify the Roles of Different Insurance in Resolving Medical Disputes
Medical disputes may arise due to unavoidable complications or institutional negligence. For disputes caused by institutional errors, compensation must be covered by Medical Malpractice Insurance (purchased solely by institutions). For incidents where institutions are not at fault, patients may voluntarily purchase Medical Accident Insurance to alleviate financial burdens from ongoing treatment.
II. Standardize Management of Medical Accident Insurance
- Encourage Product Innovation: Develop insurance products like surgical accident insurance, drug adverse reaction insurance, and blood transfusion infection insurance based on patient needs, following principles of voluntariness, cost-effectiveness, and market regulation.
- Prohibit Institutional Involvement: Institutions without Medical Malpractice Insurance shall not facilitate insurance sales on-site. Those offering Medical Accident Insurance must only provide office space and promotional materials, refraining from involvement in insurance operations.
- Prevent Coercion: Medical staff must not link insurance purchases to hospital admissions or procedures, nor accept benefits from insurers. Institutions must monitor and penalize violations.
- Verify Insurer Credentials: Institutions must confirm the legitimacy of insurers and their agents, reviewing contracts and qualifications.
- Supervisory Role of Health Authorities: District health commissions shall inspect Medical Accident Insurance practices, mandating corrective actions for non-compliance.
- Insurance Compliance: Insurers must operate lawfully, avoiding coercion and submitting monthly reports as per Annex requirements.
III. Standardize Management of Medical Malpractice Insurance
- Eliminate Retroactive Policies: Insurers must ensure timely renewals without post-dated policies. Institutions must submit accurate materials to avoid uninsured periods.
- Streamline Claims Processing:
- For clear-cut cases: Insurers must confirm liability within 30 natural days and pay compensation within 10 days of agreement.
- For rejected claims: Written notices must be issued within 3 days.
- For complex cases: Pre-payments must be made within 60 days of claim submission, with final adjustments later.
- Internal Controls: Insurers must improve systems for tracking claims timelines and standardize documentation.
IV. Regulate Insurance Terms and Rates
- All insurance terms and rates must be filed with regulators and strictly adhered to.
- Insurers shall adjust rates periodically to maintain balanced profitability and sustainability.
V. Enhance Medical Malpractice Insurance Coverage
District health commissions must ensure all tier-one and above public institutions are insured. Non-compliant institutions may lose “Safe Hospital” designations.
Beijing Municipal Health Commission
China Banking and Insurance Regulatory Commission Beijing Office
September 21, 2017
Annex: Medical Accident Insurance Report Form
(Template for quarterly submissions by insurers)
End of Document