金融监管总局发布关于推动健康保险高质量发展的指导意见

Core Viewpoint - The National Financial Regulatory Administration has issued guidelines to promote the high-quality development of health insurance, aiming for a more integrated and diverse health insurance market by 2030, enhancing its role in the national health security system [1][3]. Group 1: Overall Requirements - The guidelines emphasize the importance of health insurance in the national health security system, aiming for a collaborative development of group and individual health insurance to meet diverse needs across the population and lifecycle by 2030 [3]. Group 2: Deepening Health Insurance Reform - The guidelines advocate for the active development of commercial medical insurance, creating a comprehensive and multi-tiered product system that includes new medical technologies and treatments [4]. - There is a push for the development of commercial long-term care insurance and disability income loss insurance, aligning with home, community, and institutional care needs [4]. - The guidelines call for the steady development of disease insurance, with regular updates to disease definitions and incidence rates [5]. - Integration of health insurance with health management is encouraged, promoting a new service system that combines prevention, management, and protection [5]. - Collaboration with the health industry is emphasized, aiming for a synergistic development between health insurance and medical services [5]. Group 3: Enhancing Sustainable Development Capacity - The guidelines stress the need for strengthening professional capabilities within insurance companies and improving actuarial practices [7]. - There is a focus on advancing digital transformation in health insurance, utilizing technologies like AI and big data to enhance operational efficiency and customer satisfaction [7]. - The guidelines encourage health insurance companies to explore innovative business models that integrate health management with insurance products [7]. Group 4: Strengthening Health Insurance Regulation - The guidelines propose enhancing regulatory frameworks and statistical systems for health insurance, ensuring compliance and fair pricing [8]. - There is a call for improved market order and performance management within insurance companies, including better handling of customer complaints [8]. - Strict measures against illegal activities in the insurance market are outlined to maintain order and protect consumer rights [8]. Group 5: Optimizing the Health Insurance Development Environment - The establishment of industry standards and simplified insurance terms is encouraged to enhance clarity and accessibility for consumers [9]. - Collaboration among regulatory bodies, industry organizations, and local governments is promoted to support the development of tailored health insurance products [9]. - The guidelines highlight the importance of public education on health insurance to improve awareness and self-management among the population [9].