[Viewpoint] The dilemma and difficulty of integrating medical model

Commercial insurance can not affect the medical service providers and carry out medical control fees. Actually, commercial insurance has not been able to solve the medical waste caused by excessive medical treatment, fraud, and unreasonable treatment. At this stage, the number of customers of commercial insurance is small, and the service party is in an absolute quantity advantage. Whether it is bargaining or payment rules, it can only intervene from the user's behavior and risk management, and there is no way to affect the medical service provider. behavior.

Therefore, in recent years, many commercial insurance companies have chosen to enter the service side, and many insurance companies have stepped out of the process of acquiring hospitals. Some insurance companies have directly acquired hospitals across the country in an attempt to form a closed loop of payment plus services in the future. However, this road is facing difficulties such as administrative bottlenecks, scattered medical resources, high capital requirements, and difficult integration.

The first challenge comes from the acquisition itself. Most of the quality service providers are in the system, and the good service providers in the system are difficult to acquire. At present, insurance companies entering the service sector mostly aim to acquire hospitals of a certain scale. The difficulties in entering the hospital within the system are multifaceted. First, the really good service providers are too large and it is unlikely to go out of the system from an administrative perspective. Therefore, the hospitals most likely to be acquired by private capital are mostly second-rate hospitals, and the acquisition of second- and third-tier cities is less difficult. However, the geographic location of these medical institutions does not match the users of commercial insurance. At this stage, commercial insurance is still developing in the first-tier cities. It is very difficult to conduct service-side acquisitions in these areas.

[Viewpoint] The dilemma and difficulty of integrating medical model

At the same time, the acquisition of hospitals is extremely costly and requires long-term operation and management innovation to increase the value of hospital services. In particular, hospitals that have been transferred from within the system face multiple problems such as personnel placement, compensation and benefits, and cost control. In five years, it is impossible to complete the reform and reflect the effect. Therefore, even if insurance companies have strong capital to acquire these hospitals, the management and reforms will be time-consuming and labor-intensive.

Second, the premise of integrating insurance and medical services is the clustering effect, that is, the intensive ownership of medical services in a certain area (such as Caesars Medical in California), in order to generate market influence in this area, to control the region. Medical services, and achieve close monitoring of the effectiveness of medical institutions to do medical control fees.

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