The Rise of Private Health Insurance in China

The overarching1overarching首要的；概莫能外的。demand for private health care in the Chinese mainland presents huge opportunities for insurance companies with the right strategies.中国大陆对私人健康服务的需求异常突出，为战略得当的保险公司带来巨大机遇。

In 2015, to identify risks and opportunities for private health insurance providers in China, EY3安永，全球四大会计师事务所之一。surveyed 2,000 targeted consumers in major cities across the country. Several significant factors are influencing consumer purchasing behavior and the shift from public to private health plans: technology, aging and urbanizing population, rising health costs, the need for private hospitals and China’s regulatory and tax systems.

1.Technology in health care

2015年，为了帮助中国私人健康保险公司识别风险与机遇，安永在全国主要城市调查了2000名目标客户。影响消费者购买行为、促使消费者从公共医疗转向私人健康保险的一些重要因素为：技术、人口老龄化与城镇化、不断攀升的医疗成本、对私立医院的需求、中国法规及税收制度。

1.医疗服务技术

[2] Consumer demand for better, direct care and internet connectivity on mobile devices has unlocked a wealth of4a wealth of大量的，丰富的。new opportunities. Integrating wearable devices and smartphones will help health insurers improve the customer experience and provide an incentive5incentive诱因，刺激。for healthy behavior.

[3] At the heart of China’s health care technology revolution are mobile phone apps that are changing consumer behavior. Many Chinese skipped desktop computers entirely and moved to smartphones or tablets. Of approximately 700 million people with internet access in China, 86%connect through their phones.

[4] Mobile platforms now streamline6streamline简化。payments of medical expenses at hospitals and enable users to circumvent7cir-cumven 避开。hospital waiting rooms and connect with medical practitioners online. For example,a digital subsidiary of Ping An Insurance,provides 24-hour one-on-one consultation with specialists and doctors through a convenient app. The service enrolled 25 million users within six months.

2.Aging, urbanizing population

[5] Since 2001, public spending has surpassed private spending as a proportion of total health care expenditure. Health care expenditures as a percentage of China’s total gross domestic product are expected to increase between 9.5%–11.8% through 2018,reaching an estimated RMB5.7 trillion.

[2]客户对更好、更直接的医疗服务的需求，而移动端的互联网接入，开启了许多新机遇。集成式可穿戴设备和智能手机将帮助健康保险公司提升客户体验，激励健康生活方式。

[3]中国医疗服务技术革命的核心就是正在改变客户行为的手机应用程序。许多中国人已经完全不用台式电脑，转而使用智能手机或平板电脑。中国有近7亿网民，其中86%的人通过手机上网。

[4]现在，移动平台让医院的诊疗费支付更便捷，用户也不用挤在医院候诊室而选择在线问诊。比如，平安保险的一家数字子公司通过便捷的应用程序提供24小时一对一专家和医生咨询，6个月内吸引了2500万名注册用户。

2.人口老龄化与城镇化

[5] 2001年以来，医疗服务开支中公共支出的比例已超过个人支出。医疗开支占中国国内生产总值的比例预计将在2018年上升9.5%—11.8%，达约人民币5.7万亿元。

[6] Despite providing universal coverage to China’s population, current public health insurance systems are insuf fi cient to cover the costs incurred,particularly for extended inpatient care.The issue becomes more severe as China’s population ages.

[7] Currently, 15.5% of China’s population is above 60 years old. By 2050,one-quarter of the population is expected to be 65 and over; half will be 45 and older. Due to the One-Child Policy and rising cost of living, the fertility rate8fertility rate生育率。dropped from 29.2 per 1,000 in 2002 to 12.2 per 1,000 in 2011. Although the One-Child Policy was changed in 2015 to allow families to have two children,many have been reluctant to have a second child due to high costs. Even if having two children becomes the norm in China, it will be more than two decades before a bene fi t is realized.

[8] China’s population is also increasingly urban. By 2050, 73% of the population will be living in an urban area, meaning that cities will struggle to provide low-cost, quality health care.

3. Looming99 looming隐隐约约的；正在逼近的。crunch10crunch财政紧缩；困境。for public health insurance

[9] Three public health insurance plans are collectively called Basic Medical Insurance (BMI)11我国基本医疗保险制度覆盖全体城乡居民。城镇职工医保针对城镇从业人员，由个人和单位共同缴纳；城镇居民医保针对没有正式工作编制的城镇居民，由个人缴纳为主，政府补助为辅；新型农村合作医疗针对没有正式工作编制的农村居民，以个人缴纳、集体扶持和政府补助的方式共同筹集资金。: the Urban Employee Basic Medical Insurance plan(UEBMI); the Urban Resident Basic Medical Insurance plan (URBMI); and the New Cooperative Medical Service(NCMS). However, plans were announced in January 2016 to merge the URBMI and NCMS plans to universalize coverage and reimbursement rates.

[6]目前的公共医保体系虽然全面覆盖了中国人口，但是还不足以抵补所有医疗费用，特别是长期住院治疗的费用。随着中国人口老龄化态势加剧，这个问题会越来越严重。

[7]目前，中国60岁以上人口占15.5%。到2050年，65岁及65岁以上的老人预计将占人口总数的四分之一，45岁及45岁以上的将占半数。由于独生子女政策以及不断上涨的生活成本，生育率已从2002年的29.2‰降为2011年的12.2‰。虽然独生子女政策在2015年转变为允许每个家庭生育两个孩子，但许多人还是因为成本太高而不愿意生二胎。就算二孩成为常态，也仍需要20多年才能收到人口红利。

[8]中国的城镇人口也在增长。到2050年，73%的人口将会生活在城市地区，这意味着各城市将难以提供低成本、高质量的医疗服务。

3.公共医疗保险的燃眉之急

[10] These systems cover 97% of the population. Actual coverage is minimal12minimal最小的，最低（限度）的。,with large disparity13disparity 不同；差距。between plans and high out-of-pocket spending. There is a looming funding crunch as health care expenditures outgrow14outgrow 因长大而不再适用；长得比……快。public funding. If no action is taken, the general fund will accrue15accrue 形成；累积。an outstanding debt of RMB735 billion by 2024. The government will need to either subsidize this funding de ficit or reduce coverage.

4.Rising health care costs create a funding gap

[11] For 30 years after the People’s Republic of China was established, the government subsidized more than half of the costs of hospitals and clinics.Hospitals were losing money on every new patient.

[12] To make up for the shortfall and enable hospitals to remain solvent16solvent有偿付能力；无债务。, the government allowed a 15% pro fi t margin on drugs and set prices for new and hightech diagnostic services at above cost.This created the incentive for doctors and hospitals to pass on costs to patients. The funding gap also leads to hospitals competing for patients—even when patient needs may be better served at different institutions. Under current conditions,the cost of health care can only increase.

[9]以下三种公共医疗保险计划统称为基本医疗保险：城镇职工基本医疗保险计划、城镇居民基本医疗保险计划和新型合作医疗服务。不过，2016年1月又公布了将城镇职工医保与城镇居民医保合二为一的计划，使医保覆盖范围更广、报销比例更大。

[10]这些体系覆盖了97%的人口。实际覆盖率并没有那么高，各项计划与高昂的自费支出之间仍然存在巨大差距。医疗支出增速高于公共基金增速，资金危机迫在眉睫。若不采取行动，到2024年，公共基金将会累积起人民币7350亿元的巨额债务。政府要么填补资金缺口，要么就得缩小医保的赔付范围。

4.不断攀升的医疗成本形成资金缺口

[11]中华人民共和国成立后的30年里，政府补贴了医院和诊所一半以上的开销。医院每增加一个病患，就亏上一笔。

[12]为了弥补亏空，使医院不至负债运营，政府允许药品有15%的利润，允许高新技术诊断服务的收费高于成本价。这促使医生和医院将成本转嫁给病人。资金缺口还导致医院争抢患者——哪怕别的医院能更好地满足患者的需求。当前形势下，医疗成本只会上涨。

5.VIP wards and private hospitals

[13] Seeing a doctor at a public Chinese hospital is not easy. Patients usually wait in line to take a number just to be allowed to make an appointment.Scalpers17scalper 黄牛。can run a thriving practice trading numbers outside hospitals. The more affluent are increasingly avoiding this treatment by paying for “VIP wards” at public hospitals. These offer patients more personal treatment and higher standard rooms than the regular wards. The hospital gets a new revenue stream while satisfying patients’ demands.

[14] The government, however, caps18cap限额收取（或支出）。the space allowed for such facilities at 10% of total hospital capacity. So despite a traditional preference among the Chinese for public hospitals—which have in the past attracted more notable doctors and are reputed to exist for the public good rather than pro fi t—private health care is growing rapidly.

What matters to consumers

Lack of confidence to cover major health problems

5.VIP病房和私立医院

[13]在中国公立医院看病并不容易。患者通常需要排队预约挂号。黄牛在医院外面卖号，生意红火。为了不遭罪，生活富裕的人越来越多地选择公立医院的“VIP病房”。跟普通病房相比，VIP病房的诊疗服务更为个性化，病房设施也更高级。医院在满足患者需求的同时获得了新的收入来源。

[14]然而，政府将这类设施的空间限制在医院总病房数的10%。因此，尽管中国人向来偏爱公立医院——过去，这些医院吸引了更多知名医生，享有“只为公益、不为私利”的美誉——私人健康服务也迅速发展起来。

消费者在意的是什么

担心大病医疗负担不起

[15]由于公共医保的赤字问题，自费医疗支出成了中国消费者的一大忧虑。受访者普遍都尝试过为意外出现的健康问题而存钱。然而，33% 的人称自己没有存款，40% 的人存款在10 万元以下，而此金额不足以应对严重的突发疾病。

[15] Due to deficits in public health insurance coverage, out-of-pocket health spending is a major concern for Chinese consumers. Survey respondents have generally tried to save money for unexpected health problems. Nonetheless, 33% reported no savings, and 40% saved RMB99,999 or less, an inadequate amount to deal with serious health emergencies.

Skyrocketing drug costs

[16] Drug costs are a major concern,and despite the Chinese Government’s best attempts to bring costs under control through its Essential Drug List(EDL)19从2009年开始，中国通过实施基本药物制度，在保障民众安全用药的前提下努力降低药品价格。所谓基本药物，就是指被列入国家基本药物目录的药品，这些药品剂型适宜、价格合理、供应有保障。, prices continue to rise. Among the survey respondents, 77% reported that they had been prescribed drugs not covered by the EDL. When asked about the most important services in their private health insurance plan, 65% cited extended prescription drug coverage.

Employer-provided health insurance

[17] 65% of the survey respondents were offered private health insurance through their employers. The vast majority accepted the coverage, suggesting that Chinese companies are interested in utilizing group health insurance plans as a bene fi t to attract and retain top talent.

药费飞涨

[16]药费是个主要关心的问题——尽管中国政府竭力通过基本药物目录控制成本，药价仍持续上涨。77%的受访者称曾经被开过基本药物目录之外的处方药。当被问及他们私人健康保险计划中最重要的服务时，65%的人认为是处方药承保范围的扩大。

雇主提供的健康保险

[17] 65%的受访者的雇主提供私人健康保险，绝大多数都选择参保，这表明中国企业有意利用团体健康保险计划这项福利来吸引和留住顶尖人才。

Chinese private insurers

[18] The dominant players in China’s private health insurance market are large domestic insurers. The market is highly competitive. Chinese insurers are beginning to differentiate their products with a range of innovations and partnerships.These include technology-driven products and sales solutions, including the use of mobile street-side stalls to perform basic diagnostic tests and market and sell insurance products, direct sales over the internet, and internet-based brokerages20brokerage 中间人业务。.

[19] Other initiatives include partnering with private hospital operators. In March 2016, the Hong Kong private clinic chain Human Health Holdings announced a plan to establish three health care centers in Shanghai and to further expand into China’s biggest cities in a joint venture with Ping An Insurance.

[20] In May 2016, Sunshine Insurance Group invested RMB3 billion to set up Sunshine Union Hospital in Weifang,Shandong Province, in partnership with that city’s government. The hospital has a capacity of 2,000 beds.

[21] Such schemes should allow for21allow for考虑到。efficient management of health care costs and sharing of patient data, the lack of which is currently one of the biggest obstacles for insurance companies to manage risk.

中国经营私人保险的公司

[18]中国私人健康保险市场的领军者是国内大型保险公司。市场竞争非常激烈。中国的保险公司正开始通过一系列的创新与合作来推出差异化的产品——提供技术驱动型产品和销售解决方案，包括设立流动推销点来做基本诊断性检查和保险产品推销、网上直销，以及网上代理。

[19]其余措施还包括与私立医院运营者合作。2016年3月，香港连锁私人诊疗平台盈健医疗集团宣布，计划在上海建立三个医疗中心，并与平安保险共同成立合资公司以进一步拓展在内地各大城市的业务。

[20] 2016年5月，阳光保险集团投资了30亿元人民币，与山东省潍坊市政府在当地携手成立了阳光融和医院。这家医院有2000张床位。

[21] 这类合作方案应把提升成本管理效率和共享病人数据纳入考虑范围，这两方面的不足正是目前保险公司控制风险的最大障碍之一。

Tax subsidies and health insurance

[22] To help make up for shortfalls in the public health insurance system,the Chinese Government has begun to explore tax subsidies for individuals who purchase private health insurance.The pilot program began in May 2015 and has been rolled out to a major city in each province, as well as the four municipalities that report directly to the central government—Beijing, Shanghai,Chongqing and Tianjin.

[23] Eligible private health insurance plans, which include comprehensive private health insurance plans, allow individuals to deduct up to RMB2,400 per year from taxes paid for wages and salary, remuneration for services, business operations by self-employed industrial or commercial households and/or contracted operations of enterprises partially or wholly funded by state assets.

[24] One issue with China’s tax structure is that private health insurance has been traditionally taxed as income. If the pilot program is applied nationally,it will incentivize a wider adoption of private health insurance and make it more accessible for individuals and their families. Official statements have suggested further tax incentives may be offered directly to employers to encourage the provision of private health insurance to their employees. ■

税收补贴与健康保险

[22]为了弥补公共医保的不足，中国政府开始试行对购买私人健康保险的个人进行税收补贴。试点项目始于2015年5月，已经覆盖了各省主要城市以及北京、上海、重庆、天津这四个直辖市。

[23]包括综合私人健康保险计划在内的私人健康保险计划允许符合条件的个人每年从工资与薪金所得税、劳务报酬所得税、个体工商户经营所得税及/或国有控股或独资企业的承包经营所得税中抵扣最多2400元人民币。

[24]私人健康保险过去作为收入项征税，这是中国税收结构的一个问题。如果试点项目在全国铺开，将刺激私人健康保险进一步普及，使个人及其家人更容易购买。已有官方文件表示，将直接给雇主更多的税收优惠，鼓励其为雇员提供私人健康保险。 □