Community's hospital includes in the commerce and settles a claim by inches The information asymmetry becomes the dangerous enterprise's stumbling-block

Community's hospital includes in the commerce and settles a claim by inches The information asymmetry becomes the dangerous enterprise's stumbling-block
Recently, including Chinese life insurance, the Pacific Ocean life insurance, safe life insurance, friendly nation, people protect the health in 30 insurance companies of Shanghai inside, sign the cooperative agreement with Shanghai Sixth People's Hospital, treat the hospital of community on the base to include in the commercial dangerous claims settlement range after agreeing to regard 4 such as the field forest street as. This is that medical insurance, serious disease are dangerous,etc. to settle a claim for the first time scale is unlocked to community's hospital.
All the time, the compensation range of the commercial health insurance is mainly limited to second, tertiary hospital. And the new medical reform points out clearly, will promote the proportion that citizens make a diagnosis in community's health care by a wide margin. Then, how community's hospital goes to a doctor to integrate the commerce to settle a claim and become the focus generally paid close attention to by inches. The reporter knows in the interview, though the model who had already hospitals of 4 communities unlocked, but this is far from enough, the insurance company sets out for the angle of control of risk, as to this still quite prudent.
The dangerous enterprise worries the information asymmetry
Community's hospital includes in the commerce and settles a claim by inches, for looking it should be anything win-win, the insurance company why is it so awkward? The reporter has visited company claims settlement subject relevant persons such as the safe and sound life insurance of Pacific Ocean, sea health life insurance, Thai health life insurance,etc., general reflection is: The information asymmetry exists, cause more difficult control of the risk.
The view of the insurance company is, because community's hospital should lag behind two, tertiary hospitals in such aspects as medical facilities, personnel's technology, some exists to make a diagnosis unstandardly, unreasonably, even the behavior of excessive medical treatment. And the insurance company, in order to verify in an all-round way to the whole course of making a diagnosis, rationality of the hospitalization cost, need to consult customer's detailed case history, various test, information such as the expenses of making a diagnosis. But hospital often can't offer information the while being unwilling, this insurance company and the intersection of community and the intersection of hospital and main message asymmetry.
Relax to community's hospital in settling a claim, so far as at present, because the customer is relatively in hospital in community's hospital cycle is longer, the hospitalization cost is relatively large, in terms of insurance company, more difficult control of this risk. "The commercial medical insurance when the products are calculated smartly, but accord with the experience data of second first grade and more than hospitals; The first class medical organization has a lot of not controllable human factors such as being unstandard of management, may increase the commerce dangerously to compensate wholly. " Shanghai the intersection of insurance and rising tide Pan, general secretary of trade council, say in this way.
It is reported from touch, contract finally for the first time, six city hospitals and insurance companies passed by a long negotiation course. For let insurance company rest assured, settle a claim, six city hospital and the intersection of community and hospital set up, change the place of examination the patient's message resignation system also, basic information such as including the name, address, disease diagnosis, diagnosing date, and offer for insurance trade council's and insurance company's of Shanghai reference per month.
Settling a claim has the customer of outpost of the tax office awkward
Show according to the materials of Municipal Health Bureau, 228 community health Centers in this city have already implemented the transformation in an all-round way at present, urban area make sure every have a community health station to 20,000 place of crowd basically, the journey can find a community health Center if the citizens of central urban district walk for 15 minutes, and can accept treatment and guidance of the large hospital doctor.
Hardware and software have all already been allocated, but the commerce settles a claim and can not catch up with and become customer's resistance that go to community's hospital to go to a doctor by inches. Citizens Ms. Wangs say, oneself is after the large hospital carries on surgery, the school demands to rotate to go to community's hospital to recover and observe and treat, but once transfer to community's hospital, relevant hospitalization cost,etc. cost will be probably unable to be settled a claim, the large hospital is originally in short on the berth and the cost is high in hospital, but approve in order to be settled a claim by the insurance company, it can only be in the large hospital that there is no alternative " Dawdling " .
One doctor of oncology department of Changhai hospital says, the large general hospital is when the ward is in short supply, will advise the community hospital which the patient jointly set up to carry on rehabilitation. But community's hospital usually belong to the first class hospital, not within the range of claims settlement of the commercial medical insurance, many patients often fall into and face a difficult choice.
In fact, " small disease enters the community, recover back to the community " It is the important idea of health care reform which the government advocates. The medical expert points out, common diseases such as for instance general cerebral apoplexy,etc. can be cured when going to a doctor in community's hospital, only 20% of the difficult and complicated cases and urgent critical disease patient need to go to large hospital and section hospital to treat.
Open up the path separately and facilitate the customer
Let go of the intersection of community and hospital, settle a claim, remain worry to whole, insurance company already careful to know, get mismatch that settle a claim and go to a doctor contradictory, a opened window of customer in order to change the place of examination community's hospital through arrangement or landscaped roadway of insurance kind,etc..
Pacific Ocean safe and sound life insurance settle a claim, investigate in charge of Su Xin say when being given an interview, the company settles a claim to some medical situations leniently while giving consideration to control of risk, if the customer needs curing promptly nearby because of the unexpected injury accident, as to its first visit emergency call expenses in 24 hours in community's hospital, settle a claim leniently. As to farther area, such as the detailed conditions of the medical resources of hygiene of Nanhui, Chongming area, the intersection of Nanhui and large the intersection of group and community health Center, urban community health Center of mud regional company, resurgence town community health Center of Chongming area, new river town community health Center, the Changjiang River farm worker's hospital, have already classified as the claims settlement hospital leniently.
The expert points out, according to present risk control, the insurance company just unlocks some first class hospitals with good qualification selectively too, and will set up certain threshold in settling a claim. In general, with the further promotion of the medical reform, the restriction of unlocking and going to a doctor in the hospital gradually will be a trend, how is it to reach the equilibrium of risk and interests specifically, depend on insurance company's and school's considering together, really give and insure the customer the victory.
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