Release date: 2017-02-27
The pricing and payment of mid-range value clinics has always been the biggest challenge for the model. If such value-based institutions choose the pricing method of medical insurance, they will fall into the predicament of low-cost medical high drug fees. Such pricing has no way to support doctors to obtain competitive salary through service, and is bound to fall into the old path of relying on drug rebates to support doctors. There is no way to gain the trust of the patient.
Therefore, value-based clinics that really want to do services will not choose the pricing of medical insurance, but choose a reasonable price for the diagnosis, which is the core of the doctor's value. However, in the context of China's overall diagnosis of gold being seriously underestimated, patients have become accustomed to the reality of low registration fees and high drug prices. It is impossible to change such status in the short term. Some users will be willing to obtain such a fee at their own expense. Excellent service, but it is impossible for self-funded users to support a fast-growing market.
Therefore, linkage with commercial insurance will be the key to payment. However, the mid-end insurance market, which can be linked to mid-end value clinics, is not good at all. There are two ways to develop the mid-end market. One is to develop from high-end (including individual insurance and group insurance), to reduce prices by reducing the medical network and coverage, usually to reduce the scope of medical networks, high-end private hospitals. Coverage, and coverage. The other is to add from the low-end enterprise supplement products, increase the VIP of some public hospitals, and increase the scope of protection.
However, neither of these methods is currently successful. Companies that move from the high-end are often faced with the same dilemma of migration, that is, they want to expand their user base by reducing their costs in similar product structures and service concepts. However, this mode of subtraction has three deviations in the grasp of demand. The first is the user's deviation from the demand for protection. The demand for protection by local people is biased towards the part that the basic medical insurance can't cover, especially the most dangerous part of the user's own financial situation, while the high-end people, especially the expatriates, pay more attention to the world. Guarantee.
Secondly, there is still a deviation in the demand for user services from the high-end subtraction. High-end private hospitals that meet the needs of expatriates have always been an important part of high-end services, while local people’s trust in medical capabilities is completely directed to the public system. Therefore, in the construction and focus of the medical network, there is a serious deviation in user demand. The users in the middle end need more close medical services and access to expert resources. This is why high-end medical insurance companies often lack the management of local medical resources. .
Third, high-end medical insurance companies have their own particularities in terms of channels and sales models, which are characterized by foreign-invested corporate clients and foreign brokerage agents. Although these customer resources are of high quality, the demand for high-end employees is very different from that of the middle-end and all ordinary employees. The budget for employees at different levels is different. It is difficult to directly transfer the sales channels and product recommendations of high-end organizations. To the middle, doing subtraction can't simply meet their needs.
The second method is that the main problem of addition is the deviation of product design. At present, most of these products for addition have adopted a certain amount of outpatient reimbursement, and then provide partial fixed medical reimbursement for public hospital VIP or international department. Ways, such as reimbursement of 300 yuan to 600 yuan per visit, only limited to the consultation, not reimbursed drugs and inspections. For users who want better protection or services, this approach is equivalent to limiting their use of better services, which is of low value. Adding a lot of products to be added is an upgraded version of the enterprise's enterprise supplement products. These products have a low starting point, limited protection, and the market price war is serious. In order not to increase the price, the product can provide a small protection range. The part of the medical insurance that is not reimbursed still does not provide a good complement, so its value is very low.
Therefore, the lack of suitable mid-end commercial insurance as a strong payer is the biggest obstacle to the development of mid-end value-based medical institutions.
Source: Village Diary
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