Table 1: Overview of medical and health reforms and their impact on private health insurance
Related medical and health reforms
DRG/DIP payment system
Centralised drug procurement
Dynamic adjustments to drug catalogue
Influence channels
Optimise clinical treatments
Standardise payment caps for diseases
Reduce drug prices
Regulate the selection of in-hospital medications
Results
Public hospitals
Private hospitals
Pharmaceutical company and pharmacies
Patients
Increase turnover rate of hospital beds
Cater to the demand for high-quality medical services
More generic drugs, less original drugs
Reduce medical expenses within public hospitals
Improve current clinical treatments
Increase in drug innovation
Rising demand for external medication in public hospitals, with exposure to special drug cost risks
Prescription drug diversion
Increase collaboration between pharmaceutical companies and pharmacies to boost sales through pharmacy channels
Rising demand for private/foreign hospitals, with exposure to medical cost risks
Commercial medical insurance
Expand risk coverage to bridge the gap from basic medical insurance:
- Fill protection gaps in out-of-pocket expenses for Category B drugs, specialty medications, and special medical services;
- Enable reimbursement for treatment at public international hospitals, private specialty clinics, and private hospitals.
Strengthen ecosystem collaboration:
- Leverage clinical data to drive upgrades in pricing and risk control;
Integrate value creation into the development of the healthcare industry:
- Engage in medication R&D, promoting the application of innovative medical technologies;
- Focus on diversified needs, improving the efficiency of high-end medical resource allocation;
- Extend to out-of-hospital rehabilitation, collaborating with long-term care insurance to cover the entire health management cycle.
Source: Swiss Re Institute