Currently, the biggest new development in China is the opening of the 18th National Congress of the Communist. Domestic and foreign players alike are paying close attention and familiarising themselves with the documents. This Congress will be focusing on the issue of sanitation. The 17th National Congress highlighted that health is the foundation for a person's all-round development, while the 18th National Congress of the Communist further emphasises that health is necessary in promoting one’s all-round development. In addition, the five-point comprehensive reform emphasises the push towards medical security, medical service, public health, medicine supply and supervising systems. VHS group participates in the research work during the process. 

There are a number of new policies for private-owned health institutions. Health risk management is a vital component.

——Former Member of Standing Committee of the National People’s Congress
Mr. Xiangyuan Zhu

The broad concept of health management service refers to insurance companies achieving the goals of controlling risk and improving health conditions, specifically the insured health risk factors. This is achieved through such aspects as measuring, evaluation and intervention. The services include physical examination, medical service, lifestyle management, disease management and health education. The pricing of health insurance products which provide health risk management services are divided into two kinds, depending on whether there is risk incidence, i.e., a disbursement service that relates to risk occurrence. The cost of amortising the net premium should not exceed 10% of the premium. For the service that is not highly correlated to risk occurrence or risky in nature, and calculated in a company’s operation cost, the cost of amortising additional expenses should not exceed 2% of the premium. Currently, most insurance companies are implementing this policy based on a ratio. With the further development and innovation of health risk management products, pricing is likely to be more open in the future.

——China Insurance Regulatory Commission
Dr. Hang Li

Before 1975， health insurance was mainly focused on the aspects of insurance sales and claims, which are rather passive and rely on product design to decrease the claim rate. After 1975, the mode changed from passive to active. The overall introduction of health risk management brought preventative management and early intervention; the detailed methods are more proactive, which include health screening, health promotion programmes and rewards systems. Health risk management plays an important role in the product design of individual and group insurance, which not only helps insurance companies have a more comprehensive understanding of clients before setting the premium, but also makes clients enjoy a more targeted service. In addition, it encourages them to actively cooperate to manage their own health, consequently decreasing the claim cost of insurance companies.

——Executive director of International Health Risk Management Association (IHRMA)
Mr Len Deacon

As a professional third-party health risk management institution which has cooperated with more than half the domestic insurance companies, and based on the experience in and understanding of the health risk management market over the years, VHS group tries to analyse specific implementation details. For the modules of health risk management insurance products,  within which “disbursement services are calculated to claim disbursement, the cost of amortising the net premium should not exceed 10% of the premium.” The service should be an “intervening service”, which is suitable to be included in risk premium (net premium) calculations. The “intervening” health risk management services include, but are not limited to, the following: a telephone consultation with a doctor, international/domestic medical second opinion, medical guidance and support, active health management, and personal physical examination.

According to “consultation services, calculated in company operation cost, the cost of amortising in additional expense should not exceed 2% of premium”. The service should be a “basic service”, which is not suitable to be put into risk premium (net premium) calculations and is not risky in nature. The “basic” health risk management services include, but are not limited to, the followings: health archive, health evaluation, and health education. In addition, according to the programme results of the Comprehensive Intervention Programme In Metro Community (CIPM), jointly carried out by Shanghai social security, VHS group and the International Disease Management Alliance from 2008 to 2011, a decreasing incidence of major controllable chronic diseases were estimated to save medical costs by 24.5%. The cost-effectiveness of health risk management services was 1：3.17（only the saved medical cost caused by decreasing new incidences of major controllable chronic diseases was calculated. Rico Tong believes the health insurance market in China has bright prospects, and health risk management is an effective catalyst for the rapid development of health insurance. Health risk management could effectively lower insurance claim risk and guarantees the development of health insurance. The worldwide trend proves that integrated health risk management contributes to the aspects of health insurance development, which are stable growth and the counter economic cycle. The concurrent development of health insurance and health risk management must combine the strengths of multiple sides.

——VHS Group
Dr. Rico Tong

Mr Qi Xie shared his thoughts and practices of developing health risk management service insurance products under the mode of “health security and health management”, and stated that although many challenges still exist in terms of supervision, evaluating indicators and cooperation, opportunities are arising in the midst of these challenges. The only way to consistently promote health risk management concepts to clients is by changing the living habits of the insured, consistently lowering or putting off health medical insurance claims, and enhancing the service capabilities of related products in insurance companies with the help of the health risk management service network.

——Taiping Pension, Co., Ltd. Product & Actuarial Dept. Deputy General Manager
Mr. Qi Xie

The speeches of delegates elicited strong feelings in the Chief Editor of China Insurance, Mr Hua Yu. For instance, when the problem of rising medical costs was mentioned, he recalled his investigation of a successful region that has embraced national health care reform. He was shocked to know that the costs of local medical security grows at an annual rate of 30%. Given the theme of the development of health insurance and health risk management under a new policy, delegates effectively stated their views . Whether from a macro level, supervision level, international experience or operation practice standpoint, all of them acknowledged the overwhelming trend towards combining developing health insurance with health risk management. We are looking forward to the cooperation of the insurance industry to overcome difficulties. We welcome the spring of cooperation development, and hope that the international health risk management forum can be held every year and continue to gather the best voices of industry experts. 

——“China Insurance” Chief Editor
Mr. Hua Yu