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.中國大陸對私人健康服務的需求異常突出，為戰略得當的保險公司帶來巨大機遇。

In 2015, to identify risks and opportunities for private health insurance providers in China, EY3安永，全球四大會計師事務所之一。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，為了幫助中國私人健康保險公司識別風險與機遇，安永在全國主要城市調查了2000名目標客戶。影響消費者購買行為、促使消費者從公共醫療轉向私人健康保險的一些重要因素為：技術、人口老齡化與城鎮化、不斷攀升的醫療成本、對私立醫院的需求、中國法規及稅收制度。

1.醫療服務技術

[2] Consumer demand for better, direct care and internet connectivity on mobile devices has unlocked a wealth of4a wealth of大量的，豐富的。new opportunities. Integrating wearable devices and smartphones will help health insurers improve the customer experience and provide an incentive5incentive誘因，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簡化。payments of medical expenses at hospitals and enable users to circumvent7cir-cumven 避開。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]客戶對更好、更直接的醫療服務的需求，而移動端的互聯網接入，開啟了許多新機遇。集成式可穿戴設備和智能手機將幫助健康保險公司提升客戶體驗，激勵健康生活方式。

[3]中國醫療服務技術革命的核心就是正在改變客戶行為的手機應用程序。許多中國人已經完全不用臺式電腦，轉而使用智能手機或平板電腦。中國有近7億網民，其中86%的人通過手機上網。

[4]現在，移動平臺讓醫院的診療費支付更便捷，用戶也不用擠在醫院候診室而選擇在線問診。比如，平安保險的一家數字子公司通過便捷的應用程序提供24小時一對一專家和醫生咨詢，6個月內吸引了2500萬名注冊用戶。

2.人口老齡化與城鎮化

[5] 2001年以來，醫療服務開支中公共支出的比例已超過個人支出。醫療開支占中國國內生產總值的比例預計將在2018年上升9.5%—11.8%，達約人民幣5.7萬億元。

[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隱隱約約的；正在逼近的。crunch10crunch財政緊縮；困境。for public health insurance

[9] Three public health insurance plans are collectively called Basic Medical Insurance (BMI)11我國基本醫療保險制度覆蓋全體城鄉居民。城鎮職工醫保針對城鎮從業人員，由個人和單位共同繳納；城鎮居民醫保針對沒有正式工作編制的城鎮居民，由個人繳納為主，政府補助為輔；新型農村合作醫療針對沒有正式工作編制的農村居民，以個人繳納、集體扶持和政府補助的方式共同籌集資金。: 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]目前的公共醫保體系雖然全面覆蓋了中國人口，但是還不足以抵補所有醫療費用，特別是長期住院治療的費用。隨著中國人口老齡化態勢加劇，這個問題會越來越嚴重。

[7]目前，中國60歲以上人口占15.5%。到2050年，65歲及65歲以上的老人預計將占人口總數的四分之一，45歲及45歲以上的將占半數。由于獨生子女政策以及不斷上漲的生活成本，生育率已從2002年的29.2‰降為2011年的12.2‰。雖然獨生子女政策在2015年轉變為允許每個家庭生育兩個孩子，但許多人還是因為成本太高而不愿意生二胎。就算二孩成為常態，也仍需要20多年才能收到人口紅利。

[8]中國的城鎮人口也在增長。到2050年，73%的人口將會生活在城市地區，這意味著各城市將難以提供低成本、高質量的醫療服務。

3.公共醫療保險的燃眉之急

[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 因長大而不再適用；長得比……快。public funding. If no action is taken, the general fund will accrue15accrue 形成；累積。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有償付能力；無債務。, 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]以下三種公共醫療保險計劃統稱為基本醫療保險：城鎮職工基本醫療保險計劃、城鎮居民基本醫療保險計劃和新型合作醫療服務。不過，2016年1月又公布了將城鎮職工醫保與城鎮居民醫保合二為一的計劃，使醫保覆蓋范圍更廣、報銷比例更大。

[10]這些體系覆蓋了97%的人口。實際覆蓋率并沒有那么高，各項計劃與高昂的自費支出之間仍然存在巨大差距。醫療支出增速高于公共基金增速，資金危機迫在眉睫。若不采取行動，到2024年，公共基金將會累積起人民幣7350億元的巨額債務。政府要么填補資金缺口，要么就得縮小醫保的賠付范圍。

4.不斷攀升的醫療成本形成資金缺口

[11]中華人民共和國成立后的30年里，政府補貼了醫院和診所一半以上的開銷。醫院每增加一個病患，就虧上一筆。

[12]為了彌補虧空，使醫院不至負債運營，政府允許藥品有15%的利潤，允許高新技術診斷服務的收費高于成本價。這促使醫生和醫院將成本轉嫁給病人。資金缺口還導致醫院爭搶患者——哪怕別的醫院能更好地滿足患者的需求。當前形勢下，醫療成本只會上漲。

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 黃牛。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限額收取（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病房和私立醫院

[13]在中國公立醫院看病并不容易。患者通常需要排隊預約掛號。黃牛在醫院外面賣號，生意紅火。為了不遭罪，生活富裕的人越來越多地選擇公立醫院的“VIP病房”。跟普通病房相比，VIP病房的診療服務更為個性化，病房設施也更高級。醫院在滿足患者需求的同時獲得了新的收入來源。

[14]然而，政府將這類設施的空間限制在醫院總病房數的10%。因此，盡管中國人向來偏愛公立醫院——過去，這些醫院吸引了更多知名醫生，享有“只為公益、不為私利”的美譽——私人健康服務也迅速發展起來。

消費者在意的是什么

擔心大病醫療負擔不起

[15]由于公共醫保的赤字問題，自費醫療支出成了中國消費者的一大憂慮。受訪者普遍都嘗試過為意外出現的健康問題而存錢。然而，33% 的人稱自己沒有存款，40% 的人存款在10 萬元以下，而此金額不足以應對嚴重的突發疾病。

[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從2009年開始，中國通過實施基本藥物制度，在保障民眾安全用藥的前提下努力降低藥品價格。所謂基本藥物，就是指被列入國家基本藥物目錄的藥品，這些藥品劑型適宜、價格合理、供應有保障。, 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.

藥費飛漲

[16]藥費是個主要關心的問題——盡管中國政府竭力通過基本藥物目錄控制成本，藥價仍持續上漲。77%的受訪者稱曾經被開過基本藥物目錄之外的處方藥。當被問及他們私人健康保險計劃中最重要的服務時，65%的人認為是處方藥承保范圍的擴大。

雇主提供的健康保險

[17] 65%的受訪者的雇主提供私人健康保險，絕大多數都選擇參保，這表明中國企業有意利用團體健康保險計劃這項福利來吸引和留住頂尖人才。

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 中間人業務。.

[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考慮到。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.

中國經營私人保險的公司

[18]中國私人健康保險市場的領軍者是國內大型保險公司。市場競爭非常激烈。中國的保險公司正開始通過一系列的創新與合作來推出差異化的產品——提供技術驅動型產品和銷售解決方案，包括設立流動推銷點來做基本診斷性檢查和保險產品推銷、網上直銷，以及網上代理。

[19]其余措施還包括與私立醫院運營者合作。2016年3月，香港連鎖私人診療平臺盈健醫療集團宣布，計劃在上海建立三個醫療中心，并與平安保險共同成立合資公司以進一步拓展在內地各大城市的業務。

[20] 2016年5月，陽光保險集團投資了30億元人民幣，與山東省濰坊市政府在當地攜手成立了陽光融和醫院。這家醫院有2000張床位。

[21] 這類合作方案應把提升成本管理效率和共享病人數據納入考慮范圍，這兩方面的不足正是目前保險公司控制風險的最大障礙之一。

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. ■

稅收補貼與健康保險

[22]為了彌補公共醫保的不足，中國政府開始試行對購買私人健康保險的個人進行稅收補貼。試點項目始于2015年5月，已經覆蓋了各省主要城市以及北京、上海、重慶、天津這四個直轄市。

[23]包括綜合私人健康保險計劃在內的私人健康保險計劃允許符合條件的個人每年從工資與薪金所得稅、勞務報酬所得稅、個體工商戶經營所得稅及/或國有控股或獨資企業的承包經營所得稅中抵扣最多2400元人民幣。

[24]私人健康保險過去作為收入項征稅，這是中國稅收結構的一個問題。如果試點項目在全國鋪開，將刺激私人健康保險進一步普及，使個人及其家人更容易購買。已有官方文件表示，將直接給雇主更多的稅收優惠，鼓勵其為雇員提供私人健康保險。 □