The commercial insurance

The commercial insurance
Commercial medical insurance is the medical insurance as a special commodity, free operation of medical insurance mode according to the laws of the market.In the medical insurance market, the seller is refers to the profit or non-profit private health insurance companies or private health insurance companies;The buyer can be enterprises, social organizations, also can be the government or individuals.Commercial medical insurance personal primarily funded by participants and their employers pay of insurance premium, in general, the government fiscal investment, or subsidies.The United States is a typical representative of the implementation of commercial medical insurance mode.Although the United States government held the medical care system, medical assistance system, and minority free medical care and other social medical insurance plan, but in the whole system of medical insurance, they do not occupy the main position, the cover of people is limited.In the United States, more than 80% of the national civil servants, private enterprise employees and farmers are not protected by the social insurance, but took part in the commercial insurance system.The national commercial medical insurance fund has more than 1800.Commercial health insurance in the United States is divided into non-profit and for-profit two kinds, the former can enjoy preferential treatment in taxation, which do not enjoy the treatment of the related.Is the feature of the commercial medical insurance model, mainly by the market operation and management of medical treatment insurance, the government only responsible for the elderly and the poor health care.Insurance funds is mainly borne by individuals and enterprises, government basic no burden.The model of the outstanding problems is the social fairness is poorer, there are quite a lot of low-income employees of small businesses, individual worker and peasant family do not have medical insurance.

United States: commercial medical insurance loopholes
Around the world, by private commercial insurance as the backbone of the country medical security system, but the United States.Commercial health insurance companies is to make money.In order to make money, the company is not willing to sell insurance policies to the high risk people.Therefore, the commercial medical insurance is hard to cover the old man.Commercial health insurance is also difficult to cover the poor, because they can't afford to pay the premium.From this perspective, the commercial health insurance anyway cannot achieve universal health care, fairness is poor.However, the us government to keep the bottom line, a market economy, the government should at least do this is to use the public finance to the market fails to cover the public to provide public services.Since the commercial medical insurance to cover the elderly and the poor, the U.S. government has set the health care system designed specifically for the old man (Medicare), specially set up the medical assistance system for the poor (Medicaid).Medical care is a mandatory health insurance, the government to impose social security tax (also known as social security taxes) helping to collect the premium and medical treatment of the money comes from government fiscal, Shared by federal and state governments.These two public health care system to cover the 45% of U.S. residents.Commercial medical insurance, however, even in the elderly and the poor also cannot achieve universal coverage of the general population.The latest population statistics show that in 2005, 46.6 million people had no health insurance, 15.9% of U.S. residents.The Numbers over the years in between 14% and 20%.In other words, the private medical insurance institutions insured people about 35% to 41% of the total number of U.S. residents.Another disadvantage of commercial medical insurance is the high cost of health care.People pay insurance premiums on statistical stray into "medical expenses", in the practical part of the profits of insurance company.In addition, the professionals of high salary, high on the world's first commercial health insurance company's management fees.America's health service highly marketable.Most clinics, hospitals and other specialized medical institutions are private, many are non-profit organizations, there are many is a for-profit company.Governments at all levels and the establishment of some medical institutions in the United States, mainly in order to make up for a lack of market, in rural and remote areas to set up community health center, also set up a few public hospitals in some cities.Whether private or public, for-profit or nonprofit medical institutions compete with contract of various kinds of health care institutions.Health care institutions including government sponsored health care and medical treatment, and various private health insurance company or a non-profit organization.Medical institutions in order to attract patients, so as to win the contract more health care institutions, on the improve the level of medical services and medical technology has launched a fierce competition.
The disadvantage of the American model universally acknowledged, even the American social policy experts have no objection.The voice of the medical security system reform in the United States' larger all the time, but any strengthening government function, the implementation of mandatory social insurance scheme is due to the intense opposition from the insurance industry and medical services to become law.

Characteristics of the commercial medical insurance
Commercial health insurance is also called
Health insurance, is based on the human body the subject-matter insured, the insured due to disease or accident harm to cause of medical treatment cost and the income loss to compensate.Commercial medical insurance in China start time is not long, in the insurance consciousness, insurance depth and insurance density and coverage development, premium income, operation and management, etc, compared with western developed countries insurance, there is a larger gap.In addition due to subject to the management risk of the commercial medical insurance is higher and the technical management requirements, coupled with the lack of rich market experience, domestic insurance companies for the development of medical insurance are a cautious attitude, causes our country medical insurance coverage set up by an insurance company is single, inadequate safeguard function, and the volume is small.After China's entry into the wto, the insurance access will gradually open, our country insurance company in the fierce competition of how to don't lose the commercial medical insurance market, this article obtains from the analysis of the commercial medical insurance mechanism, product development strategy of China's commercial health insurance are discussed.

The United States commercial medical treatment
Characteristics and advantages of insurance products 1. The commercial medical insurance system introduction to the world in modern history, the emergence of the commercial health insurance only one hundred years of history, but it has been widely used all over the world provide health care services for the national health insurance way, due to the different actual situation, so he formed the different medical insurance system, basically can be divided into the following two types, one is the private commercial insurance pattern, the second is the national health insurance mode.The United States is a private commercial insurance pattern.Under the private commercial insurance pattern, the medical service is given priority to with personal consumption, the government of special crowd (old age, disability, low income, etc.) to provide cost benefits, or the use of special medical insurance.Most countries only a small part of the burden of medical insurance, transferred to the patient or enterprise.Under this model, not only the economic burden of the government, and make the maximum development of commercial medical insurance market, insurance companies under the system of loose, reasonably according to the requirements of the market for the development of insurance breed.

American commercial health insurance product development strategy under the private commercial insurance pattern, because the doctors often opened by individuals and as members of the various organizations and groups, private hospitals than state-owned public hospitals, and so on medical expenses of the private hospitals have considerable autonomy, from
To constantly improve the medical service cost, at the same time, the commercial medical insurance market is growing.In this case, the insurance company mainly on medical insurance product development strategy to expand and stable customer group, promote the main insurance products.Embodied in the following aspects: (1) pay attention to the brand strategy.Insurance companies in the United States in the process of product development, in order to strengthen the company's image, stability and expanding customer base, often pays attention to the promotion of the main risks of business, but also pays attention to the external effects of the main insurance business.To a certain extent, insurance companies in the United States at the beginning of the brand establishment often give up some interests requirement.(2) ensure that product can run long.To ensure that the product can run a long-term policy of insurance companies for long-term, comprehensive evaluation is the premise, the insurance company in the commercial medical insurance in the process of product design pays attention to the sustainability of the product characteristics.(3) pay attention to the risk.Commercial medical insurance of the risk is that the medical cost and the consumption of high-grade medical uncertainty, in the United States, because the private hospitals is more, the uncertainty is more obvious, therefore the insurance company involved in commercial health insurance products in the process, according to various medical expenses have adopted different risk assessment mechanism to determine the risk of various risks.

SAS business analysis power blue cross to participate in medical insurance reform in the United States
As U.S. President barack Obama: "America's medical insurance system reform will be related to the survival of the future."Increase the medical insurance system reform is to maximum the status of the interior, at the same time, the global focus attention on health care reform in the United States.After many years of the American medical insurance system reform by experts to analyze its difficulty lies mainly in the medical insurance organization how to control the cost, improve the health level and maximize ginseng to keep staff satisfaction.Blue cross blue shield of the United States
Using SAS (BCBS) advanced business analytics techniques successfully implement all measures to the medical insurance system reform,
Do a good try for the whole industry.The difficulties of medical insurance system reform is expected to break through.

Now almost all the blue cross blue shield of using SAS ? (BCBS) Business analysis (Business Analytics) solutions are the implementation of the medical insurance system reform measures.In the family health plans, in one of the largest and earliest 39 enterprises in addition to the four have been deployment of SAS software.Every three americans, there is a blue cross blue shield to cover health insurance, the total has more than one hundred million people.Independent business technology research institution Aite Group medical insurance division, a senior analyst at access Pandya says:
"As the reform of health care system, medical insurance agencies to reduce costs, invest in advanced technology architecture of pressure increasing. Advanced analysis technology has become an important means of cost control. This kind of advanced technology can greatly help the medical insurance company to detect fraud, through positive interaction actively manage risk, and improve the efficiency of the system in other fields and benefit level."Dialysis SAS business analysis of SAS is the world's leading supplier of business analytics software and services, and business intelligence market of the largest independent manufacturer.By including many innovative solutions in an overall framework, SAS help more than 45000 users around the world a better and faster decisions, so as to improve the performance and value.SAS Business analysis Framework (Business Analytics Framework) is a collection of data integration, analysis, and reporting features a powerful tool at an organic whole, the industry and the expansion of the solution at the grass-roots level to an unprecedented level, is advantageous for the
Enterprise solutions to the current business problems quickly, at the same time expanding the application of SAS solution to continually improve performance level.SAS technology for enterprises to build their own application laid the foundation of reliable.At the same time, SAS provides solution can fully meet the demand of the industry cost savings, improve the level of patient welfare and other aspects of the problem.

SAS solution applicable to all health insurance companies, including: l SAS ? Customer Intelligence (Customer Intelligence) improve member interaction ability and service level.L SAS ? medical Insurance fraud Framework (Faud Framework for Health Insurance) to ensure that the legitimate claims.SAS ? Disease Management (diseases Management) solutions help predict risk, optimize the interaction level, improve the health care effect.Significant advantages Excellus blue cross blue shield will SAS business analysis framework is applied to many business units, including the actuarial department, the department is responsible for the analysis of the company the risk of ginseng protect personnel to 31 in the state of New York county.Using SAS business analysis technology, Excellus now can not only check has happened in the business, but also can predict problems to come."Insurance depends on the identification and predict future risk, the company has always given prominence to this work, and after using SAS, we perform an actuarial business standard speed increased by 40% at least," Joseph Excellus actuarial manager Randazzo said, "use of save time, we can work past quite time-consuming analysis. Results are obvious: now we can better control the risk of health care plan."

Improve the level of information = improve the level of care New Jersey in the service of 3.6 million members of the horizon blue cross blue shield companies face such problems, many health care plans members of their information demands increasingly complex and comprehensive, to control the cost of the health management plan.In the deployment of SAS enterprise business intelligence
Before the Server (SAS Enterprise BI Server), and the statements
Automation dashboard growing demand become the horizon the heavy burden of the company.The insurance company in three months time achieve the return on investment.MikeOcchipinti horizon company information department manager said: "the improvement of information management and customers for horizon brought huge benefits. Ministry of information to provide business analysis results provide support for the company more than 70 important project. Only the value of a project implemented by more than 5% of millions of dollars, install the SAS solution for only three months, we will as the main customer provides automatic disease management and health report, this kind of information for improving the standard of care has very important role."