Exploring New Models for Social Management of Life Insurance: Drawing on Health Checkup Pathways and Building a Collaborative Framework for Medical Insurance Networking

Currently, the work processes and priorities of various life insurance companies are primarily focused on two areas: business development and claims processing. Business development can be achieved in two ways: one is through aggressive promotion, which customers may reluctantly accept; the other is by creating a reputation through claims processing, demonstrating that life insurance is beneficial, offering personal risk protection and benefits after a claim. These approaches fail to organically combine the needs of life insurance companies with those of their customers, and fail to truly implement the harmonious philosophy of "people-oriented" service, ensuring that customers enjoy humane services from life insurance companies both when they are healthy and while they are alive. To truly implement the "Scientific Outlook on Development" and ensure that life insurance serves the "building of a harmonious society," harmony must be achieved between the company and its customers, and between development and benefits. Guiding demand will guide business development and management onto a path of sustainable and stable growth. Drawing on the concept of sub-health in health checkups, life insurance companies should make organizing health checkups for clients a regular practice. This means shifting the focus from development and management to a three-pronged approach encompassing development, loss prevention, and management. Only by effectively managing client health and loss prevention can a company truly achieve healthy and sustainable development. The approach taken by Professor Yin Boyuan of Tianjin Medical University at the Chang'an Hospital Health Checkup Center can be adopted by the life insurance industry. First, conduct general health checkups for clients, analyzing the health information in the checkup forms to identify various disease risk factors and determine the health status of each examinee. Second, for those with different disease risk factors, further follow-up examinations should be conducted to determine their specific disease risk. Third, provide health education or prevention and treatment for sub-healthy individuals with different diseases. Fourth, conduct systematic examinations for those diagnosed with specific diseases to further clarify the diagnosis. Fifth, comprehensively evaluate all the above examinations and propose health prescriptions or treatment plans. Sixth, establish health records for all clients undergoing physical examinations, and provide follow-up healthcare services to sub-healthy and diseased individuals based on these records, recording the results in the health records. Seventh, according to the records, hold consultation meetings for sub-healthy individuals at regular intervals, categorized by disease type, to conduct specialized lectures or answer questions. This ensures a close connection between sub-healthy individuals and the life insurance company. The issue of sub-health has attracted significant attention from Party committees and governments at all levels. Almost all provincial, autonomous region, and municipal governments across the country have established a system of regular physical examinations for public officials to facilitate early disease detection and prompt intervention. The life insurance company will conduct various forms of health checkups for its clients, which aligns with the requirements of my country's current three-tiered prevention system and conforms to the overall requirements of the "Scientific Outlook on Development." Health checkups are crucial for understanding clients' health status, establishing relatively complete health records, and providing targeted interventions and treatments. This not only strengthens the company's disaster prevention and loss mitigation efforts and ensures stable operation but also plays a vital role in fully leveraging the social management functions of the life insurance company.

(II) Fully leverage the social management function of life insurance, actively establish close cooperative relationships with hospitals at all levels, urban employee medical insurance, and rural cooperative medical organizations to achieve resource sharing and complementary advantages. Modern insurance undertakes three functions: economic compensation, financing, and social management. It has added a social management function compared to the traditional definition of insurance. A common saying among life insurance professionals is: "We deal most with customers and hospitals." Because life insurance covers a person's lifespan and health, and people must go to the hospital when they are sick, close cooperative relationships with hospitals at all levels are essential. First, establish information networks with medical organizations, and then gradually build a management platform for life insurance companies. Establish a network between insurance companies and hospitals, transmitting data such as outpatient medical expenses, inpatient medical expenses, and medical history diagnoses of the insured. This extends risk control in life insurance from simply focusing on post-event risk management to the entire management process, including pre-event prevention, enabling control over life insurance claims costs and providing basic data for insurance company product design and risk selection. For example, based on the main health insurance contract, and according to the local level of medical services, a health service contract is first signed with the client. This involves providing a series of health services through community hospitals, including annual physical examinations, health education, and preventative healthcare. A complete health information file is established for the client, accessible anytime via the internet. This provides clinicians with comprehensive and detailed reference materials for client treatment and also helps the insurance company fully understand and grasp the client's detailed health status, effectively reducing moral hazard. Secondly, an attractive medical insurance cooperation framework should be constructed. When selecting designated hospitals, life insurance companies must consider factors such as the quality and convenience of the medical services the client should receive, as well as risk and cost control. They should not only focus on top-tier tertiary hospitals but should select a multi-tiered range of medical service providers, including loosely affiliated hospitals, closely connected designated hospitals, convenient community hospitals, and integrated priority hospitals, according to different standards, to meet the client's multi-level medical and health protection needs. In accordance with the State Council's "Opinions on Accelerating the Reform and Development of the Insurance Industry," participation in the management of medical institutions through equity participation or controlling stakes can improve medical services and truly achieve a unified entity of "risk sharing and benefit sharing" with medical service providers. Establishing new rules of the game, referencing the management model of "designated hospitals set up by the Urban Employees' Medical Insurance Management Center," will encourage active cooperation between hospital management and insurance companies, creating an attractive framework for collaboration. The Urban Employees' Medical Insurance Management Center is the working body of governments at all levels responsible for managing urban employees' medical insurance. It undertakes various management functions, including organizing, paying, and conducting health checkups for urban employees' basic medical care, playing an irreplaceable role in my country's medical security management. Close cooperation with the Urban Employees' Medical Insurance Management Center is crucial for learning from advanced experiences in social medical insurance management, staying informed about relevant national policies, and utilizing relevant information and data. The basic terms of commercial medical insurance in China, such as drug catalogs and regulations for various examinations, must comply with the requirements of the local social medical insurance authorities. This ensures that the policies of social medical insurance and commercial medical insurance are aligned and mutually reinforcing. To facilitate medical treatment and management for insured employees, the Urban Employees' Medical Insurance Management Center has established management agencies in various designated hospitals and medical units, signed cooperation agreements, and implemented effective management through dedicated personnel. Its management authority and the authenticity of its medical data far exceed those of commercial insurance companies. The emergence of sub-health issues and the increasing proportion of serious illnesses among urban employees have prompted governments at all levels to strengthen their requirements for health checkups for urban employees. Almost all provincial governments have established a system for regular health checkups for public officials. These checkups provide interventional treatment for those with illnesses or sub-health conditions, continuously improving the health level of public officials. The health checkup data of public officials is crucial information for commercial insurance companies; we must attach great importance to it and utilize it effectively through close cooperation.