Private Health insurance Helps International Medical Services
In recent years, Shanghai aims to become an Asian medical and international medical tourism center. With the policy support of Shanghai government, the international medical industry is developing rapidly.
To successfully expand their leading specialties globally and convert domestic recognition into international market share, many medical institutions are strengthening international cooperation, aligning with global standards, and partnering with international medical insurance providers. By joining direct billing networks, these institutions are positioning themselves competitively in the international market.
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Overview of Private Health Insurance Overseas
The United States is one of the most well developed and mature markets for private health insurance. The U.S. government offers two major health insurance programs: Medicare, for individuals over 65 and disabled persons. Meanwhile, Medicaid, for low-income individuals. These two insurance programs only cover 11 million people in the U.S. Therefore, both of the corporations and the individuals have to rely on private health insurance for healthcare coverage. Due to the big market size, the competition among American insurance companies is extremely intense, which leading to various insurance types, including Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Point-of-Service (POS), and Fee-for-Service (Indemnity) plans.
In the United Kingdom, the National Health Service (NHS) provides the majority of healthcare services in the UK with free or low-cost. Thus, only about 10% of the population chooses private health insurance to supplement NHS services.
The health insurance system in France was ranked as the "Best System" by the World Health Organization. It is composed of three parts: Basic Health Insurance, Mutual Health Insurance, and Supplementary Private Health Insurance. About 96% of citizens have supplementary private health insurance. They could customize the health benefit, for example, adjust the reimbursement percentages and benefit limits for services like dental and optical care.
In conclusion, private health insurance not only provides comprehensive risk protection for the corporations and the individuals, but also significantly propels the development of medical services by:
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The Development of International Medical Insurance in China
Actually, the predecessor of mid-to-high-end health insurance is the international commercial medical insurance, that is, International Private Medical Insurance (IPMI). It was only a global medical insurance provided by multinational companies for their expatriate employees in the past. In China, because of its high coverage of millions yuan or even tens of millions yuan, reimbursement of the latest tumor-targeting drugs and other expensive imported drugs, treatment costs in private medical providers and the ability to visit well-known foreign medical providers, IPMI has gradually evolved into the current mid-to-high-end medical insurance known.
The mid-to-high-end private health insurance is no longer the exclusive protection of multinational companies along with the improvement of living standards and the enhancement of insurance awareness among Chinese. A growing number of Chinese enterprises, corporate management, workplace elites, and middle-class families are eager to have a more comfortable medical experience, more diverse medical options, more accurate medical advice, and more efficient medical treatment process, rather than medical coverage that only satisfying their basic medical needs.?
Meanwhile, due to the adjustment of social health insurance policies as well as the release of the “three-year action plan for the reform of DRG (Diagnosis-Related Group) and DIP(Diagnosis-Intervention Package) payment methods, more market demand for private health insurance has been evoked by the national policy, especially for the private health insurance that is not integrated with social health insurance. DRG and DIP are systems used in healthcare to classify hospital cases and manage healthcare costs. Recently, a mid-end private health insurance product so called "Elite Choice" ?which is serviced by MSH CHINA, and can reimburse medical expenses incurred in VIP department and international medical department of public hospitals, has also been included in the list of private insurance that can be purchased and paid for by the personal account of Shanghai social health insurance. It is foreseeable that medical security system will continue to develop in multi-dimensions. A growing number of consumers with stronger affordability will consider purchasing the mid-to-high-end private health insurance in the future.
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How does the Domestic Private Health Insurance Make Contribution to International Medical Services in China
In recent years, the mid-to-high-end private health insurance, critical illness insurance, inpatient-only medical insurance, children’s insurance and maternity insurance, specialty drug insurance and other diversified insurance products have been continuously launched by the insurance companies. In order to satisfy the demands of the different consumers, the international departments from many tertiary public hospitals and non-public medical providers have in-depth cooperation with insurance companies and devote to the comprehensive improvement of their overall medical services, operational capabilities and technological level:
1. Improving the quality of professional medical services: The essence of healthcare services lies in medical expertise and the high-level medical resources are always scarce. Most of the international departments of tertiary public hospitals have certain standards for visiting experts as most of them are department directors and deputy chief physicians. Furthermore, the expert resources from auxiliary departments are also allocated, including B-ultrasound, gastrointestinal endoscopy, anesthesiology, pathology and other expert outpatient clinics. In the meantime, the allocation of doctors in private hospitals is also gradually focusing on specialization. The medical quality of non-public medical provider could be continuously improved by the medical alliances, multi-site practices of doctors, and cooperation with an expert team in a public hospital and other various methods. Meanwhile, a large number of excellent overseas doctors have been recruited into the private medical providers, which are one step closer to the international medical services in terms of service concepts for the high-end populations, disease treatment paths and standards.
2. Optimizing the service environment and humanized service: There are some independent outpatient treatment areas in most of the public hospitals. They provide the warmer environment and more convenient service flow on healthcare settings. These independent areas includes most of the basic laboratory examinations, outpatient infusion, observation, checkout and other functions are available but CT, MRI and other large-scale examinations. For better medical experience, the international department will make the reasonable coordination to shorten the waiting time of large-scale examinations as much as possible and schedule the exams on the same day when they visit hospital.
3. Improving the financial system and flexibly adapt to the demands of private health insurance: One of the features of private health insurance is the flexibility of product benefits, such as different deductibles, copayments, benefit limits and others in accordance with customer demand and premium requirements, which poses a huge challenge to the financial system of medical providers. At present, the international department of most public hospitals provide direct billing service to the patients who are insured with mid-high end private health insurance. Moreover, some of them even could collect deductibles and copay according to insurance benefits. Private medical providers can undertake dozens of insurance companies or more insurance products for its more flexible financial system, which is also more familiar with the insurance benefits domestically or internationally.
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4. Using the international standard information systems: Medical providers are gradually using international standard codes (ICD, CPT), electronic medical records, online appointments, Internet hospital construction, intelligent medical care and other measures to further standardize data and improve the operational efficiency. Some medical providers also use billing internationalization codes and bilingual medical records, which greatly promotes the ability of the international department of public medical provider to undertake more overseas insurance customers.
5. Improving the allocation of professionals: In addition to independent front desk staff, customer service, pharmacists, and finance, the international department of public hospitals will also set up the special private health insurance administrative staffs, or arrange special officers to run the international department and to conduct the internal and external coordination with private health insurance companies. Private hospitals are also equipped with a team dedicated to critical cases, which can assist in the critical treatment schemes for surgeries performed by the various departments, to be approved by the private health insurance companies in time.
6. Diversified and innovative services: The service contents of medical providers are no longer limited to a single pathway of offline consultation. Online medical treatment, video consultation, chronic disease management, chronic disease delivery and other diversified services are emerging gradually.
7. Actively explore the multi-dimensional cooperation: The cooperation between medical providers and private health insurance companies has been derived more in-depth cooperation models. Rather than limited to simple direct payment cooperation, medical providers are willing to design the exclusive service packages or exclusive prices for private health insurance-specific products to match different products and services. Simultaneously, medical providers also actively cooperate with the private health insurances to provide exclusive products, aim at specific groups, design the professional expertise and services of medical providers in the products, and complete the pricing calculations by the existing data model, which greatly enriches the diversity of private health insurance in the market and makes innovative attempts of customer acquisition for medical provider. In terms of online transformation, a growing number of medical providers cooperate with private health insurance to complete the data transmission and docking. From expert appointments, submission, claim data transmission, to automatic financial reconciliation, the proportion of online operation of private health insurance of medical provider is increasing yearly, which has also greatly improved the service bearing capacity of medical providers. For example, Huadong Hospital Affiliated to Fudan University, International Department provides appointment making though API (Application Programming Interface). It not only improves the appointment making efficiency, customer satisfaction, but also reduces costs and increases efficiency, to achieve a win-win situation between the medical providers and the private health insurance companies.
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The Direction for Medical Providers to Improve Their International Medical Services in The Future
In the cooperation between private health insurance companies and medical providers, both of them should adhere to the consensus of long-term partners, take medical professionalism and medical safety as the cornerstone and the greatest integrity as the criterion, to ensure the security and privacy protection of medical data, comply with data protection regulations, prevent customer privacy leakage, and achieve a win-win cooperation.
Despite the daily direct billing cooperation and operation management, facing with the vigorous development of the international medical industry, the medical providers shall also urgently strengthen talent training, integrate with international standards, improve information investment, and continuously improve service competitiveness.
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Conclusion ?
Private health insurance plays an important role in promoting the exchange and development of international medical services on a global scale, and it is a symbiotic and win-win relationship with medical providers. Private health insurance companies not only provide a stable and growing source of self-paid customers to medical providers, help medical providers to expand the proportion of private health insurance business, but also help healthcare organizations improve their global competitiveness by transferring the changing needs of clients and the best practices and innovative models of other top healthcare organizations around the world to their healthcare partners.
Under the strong support of SHDC (Shanghai Shenkang Hospital Development Center) and Shanghai Municipal Health Commission, Shanghai public hospitals are actively promoting the standardization of international medical services. Based on the guidance of policies, pricing will be more market-oriented, which will trigger a reshuffle of Shanghai international medical service market, promote sufficient market-oriented competition among the public medical provider and non-public medical provider. It will also drive the private health insurance companies to continuously adjust and innovate with market changes, adapt to the changes and develop with public hospitals in China.
We believe that the development of private health insurance will be centered on continuous product innovation driven by market demand, continuous service innovation focused on customer experience, the integration of medical resources centered on high-quality healthcare, data integration centered on automation and intelligence, and the establishment of an intelligent risk control system centered on privacy protection. We look forward to collaborating with medical institutions to create a healthy and sustainable business environment, ultimately achieving a win-win situation for private health insurance, medical institutions and global customers in the future.?
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About MSH CHINA
MSH CHINA was founded in 2001 as the Asia Pacific headquarter of MSH INTERNATIONAL. Our headquarters and operation center are in Shanghai. We have branch offices in Beijing, Guangzhou, Shenzhen, Hong Kong and Singapore as well as service offices in Chengdu, Suzhou, Dalian, Hefei, Harbin, and Wenzhou. We partner with insurance companies to provide high-quality insurance solutions as well as extensive service to corporate and individual clients. We have a professional service team consisting of 500 staff, more than 70 of them have professional medical background. We are able to provide clients with the most thoughtful service in 10+ languages, including Chinese, English, French, etc.?
Founded in 1974, MSH INTERNATIONAL is a world leader in the design and management of international healthcare solutions. Its four regional headquarters located in Paris, Toronto, Dubai and Shanghai, MSH INTERNATIONAL provides 24/7, round-the-clock assistance in 50 languages for its corporate clients and insured members across 200 countries.