Notice of the General Office of the State Council on Issuing Opinions on Accelerating the Development of Commercial Health Insurance
State Council Document No. [2014] 50
To:
People’s Governments of all provinces, autonomous regions, and municipalities directly under the Central Government; all ministries and commissions directly under the State Council, and all directly affiliated institutions:
In order to implement the requirements of the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Healthcare System, the Opinions of the State Council on Promoting the Development of the Health Service Industry (State Council Document No. [2013] 40), and the Opinions of the State Council on Accelerating the Development of Modern Insurance Services (State Council Document No. [2014] 29), this document outlines measures to accelerate the development of commercial health insurance.
I. Significance of Accelerating Commercial Health Insurance Development
Commercial health insurance refers to insurance products covering losses caused by health-related factors and medical behaviors, including medical insurance, disease insurance, disability income loss insurance, long-term care insurance, medical malpractice insurance, and medical accident insurance.
Developing commercial health insurance will:
- Complement basic medical insurance, enhance the multi-tiered healthcare security system, and meet diverse public health needs.
- Promote the health service industry, increase healthcare resource supply, and improve service systems.
- Optimize government-market dynamics and enhance efficiency in healthcare governance.
- Innovate healthcare administration systems and modernize governance capabilities.
- Contribute to economic growth, structural reforms, and improved livelihoods.
II. Overall Requirements
(A) Guiding Principles and Goals
Guided by Deng Xiaoping Theory, the "Three Represents," and the Scientific Outlook on Development, this initiative aims to:
- Leverage market mechanisms and commercial insurance expertise to expand product offerings and services.
- Position commercial health insurance as a key driver in deepening healthcare reforms, fostering the health service sector, and upgrading the economy.
Target by 2020:
- Establish a modern commercial health insurance system characterized by comprehensive coverage, diversified products, and standardized operations.
- Significantly increase commercial health insurance payouts as a proportion of total healthcare expenditures.
(B) Basic Principles
- People-Centered: Prioritize public health needs and satisfaction.
- Government Guidance and Market-Driven: Balance policy support with market innovation.
- Reform and Professionalism: Innovate service models and integrate healthcare and insurance sectors.
III. Expanding Commercial Health Insurance Offerings
(A) Diversify Insurance Products
- Align with Basic Medical Insurance: Develop supplementary products addressing gaps in basic coverage.
- Health Management Services: Offer disease prevention, wellness check-ups, chronic care, and elderly care insurance.
- Specialized Coverage:
- Medical Malpractice Insurance: Mitigate risks for healthcare providers and patients.
- Long-Term Care Insurance: Pilot programs for aging populations and chronic disease management.
- Traditional Chinese Medicine (TCM) Insurance: Cover TCM therapies and preventive care.
- Innovative Products: Address niche markets (e.g., disability care, mental health, and prosthetics).
(B) Enhance Medical Practice Insurance Coverage
- Promote medical liability and accident insurance to resolve disputes and protect both providers and patients.
- Allow individual practitioners to purchase portable insurance valid across all practice locations.
(C) Support Healthcare Innovation
- Provide preferential insurance terms for cutting-edge medical technologies and pharmaceuticals.
- Establish risk-sharing mechanisms for innovative healthcare enterprises.
IV. Improving Healthcare Insurance Systems
(A) Standardize Commercial Insurance for Major Illnesses
- Implement nationwide catastrophic illness insurance using funds from urban/rural resident healthcare programs.
- Ensure "one-stop" claims processing and dynamic fee adjustments.
(B) Expand Commercial Insurance Participation
- Encourage private insurers to administer basic healthcare programs via competitive bidding.
- Link reimbursement rates to service quality and cost controls.
(C) Foster Collaboration Between Insurers and Healthcare Providers
- Designate commercial insurers as third-party evaluators to reduce information asymmetry and medical disputes.
- Use insurance incentives to curb unnecessary medical expenses.
V. Enhancing Management and Service Standards
(A) Strengthen Institutional Frameworks
- Implement independent accounting, risk management, and data systems for health insurance.
- Establish credit systems and service quality evaluations.
(B) Improve Professional Competence
- Train specialized staff in health insurance management and claims processing.
- Adopt long-term care insurance operational standards.
(C) Optimize Services
- Provide expedited claims settlement, cross-regional reimbursement, and multichannel customer support (e.g., online portals, hotlines).
- Leverage telemedicine and big data for personalized services.
(D) Advance Digital Infrastructure
- Build secure, interoperable health insurance information systems.
- Ensure data privacy and security in insurance operations.
(E) Reinforce Supervision
- Crack down on misleading sales practices and unfair competition.
- Penalize data breaches and unauthorized disclosures of sensitive information.
VI. Policy Support Measures
(A) Interagency Coordination
- Integrate commercial health insurance into national healthcare reform agendas.
- Coordinate policy development across ministries and regions.
(B) Investment in Healthcare Services
- Encourage insurers to invest in healthcare infrastructure (e.g., hospitals, eldercare facilities).
- Secure land allocations for socially beneficial projects.
(C) Fiscal and Tax Incentives
- Refine tax deductions for corporate-sponsored supplementary insurance.
- Support private capital in establishing specialized health insurers.
(D) Public Awareness Campaigns
- Promote health insurance literacy and successful case studies.
- Establish multi-stakeholder oversight mechanisms.
State Council General Office
October 27, 2014
End of Document