慕尼黑再保险健康险系列培训课件3 美国健康保险市场 US Health Insurance Market final

1、U.S. Health Insurance Market美国健康保险市场US Health System General InformationVoluntary Health Insurance individual freedom and choice Low priority to equity As a result, it relies on voluntary private health insurance to finance health care Most private health insurance are employment-based 美国医疗卫生体系的整体情况

2、自愿参加健康保险个体的自由与选择社会公正处于次要地位其结果是依赖自愿参加的健康保险以负担医疗卫生费用大部分的私人健康保险基于雇佣形式Public/ Social SecurityPublic/ MedicaidPrivate Employers and EmployeesPrivate IndividualsFederal government (general taxation)FUNDERSEmployee (payroll tax)Employer (payroll tax)Federal government (general taxation)State/local governme

3、nts (general taxation)Employer/ employee (general taxation)Supplemental employer/ employee contributionHCFA *Employers and EmployeesState Government Medicaid OfficesIndividuals (Out-Of-Pocket)Private InsurersManaged Care OrganizationsandPrivate and Public Providers (Physicians / Hospitals)Poor, Elde

4、rly and DisabledWorkers and FamiliesThose without other Coverage* Health Care Financing Administration, an arm of the federal governmentSource: Sekhri N, Cross border health insurance, California Health Foundation and Healthcare redesign International, 1999CUSTOMERSPROVIDERSPURCHASERSElderly (over 6

5、5 years) and DisabledOrganization of the US Health Care System公立/ 社会保障公立/ Medicaid私人雇主及雇员私人个体联邦政府 (综合税)基金雇员 (工资相关税)雇主 (工资相关税)联邦政府(综合税)州政府/当地政府 (综合税)雇主/雇员 (综合税)补充的 由雇主/ 雇员 承担的部分HCFA *雇主及雇员州政府 Medicaid 办公室个人自付私人保险公司管理式医疗机构及私立及公立的医疗服务提供者 (医生 / 医院)贫困者，老年人及失能者工人及其家庭没有其它保障的人群* 医疗卫生财政管理，是联邦政府的一个机构Source: S

6、ekhri N, Cross border health insurance, California Health Foundation and Healthcare redesign International, 1999消费者医疗服务提供者购买者65岁以上老年人及失能者美国医疗卫生体系的架构Total expenditure on health, Million US$Source: OECD data美国历年的医疗卫生支出 (单位: 百万美元)Source: OECD dataTotal expenditure on health, %GDPSource: OECD data美国历年医疗

7、卫生支出占GDP的百分比Source: OECD dataUS Health System AdvantagesSignificant freedom to choose their provider Services are mostly patient-centered Rapid organizational innovations which sometimes improve efficiency and quality Consumers have most information about technical quality of medical services among

8、all advanced economies 美国的医疗卫生体系 优势对医疗服务提供者的选择有很大的自由度突出以患者为核心的服务为提高效率和质量而进行的快速机构革新消费者对所有先进系统的医疗服务的技术质量拥有最多的信息 Leaves the elderly, unemployed and the poor uncovered (tend to need more health care)Government has to finance these groups Federal Medicare coverage is available for the elderly and states

9、funded Medicaid to cover the poor. Approximately 45 million (15%) uninsured individuals in the USA US Health System Disadvantages远离更需要获得保障的弱势群体（老人，失业者及贫困的没有保险保障的人）政府必须负担这些人群联邦的Medicare是针对老年人，各州集资的 Medicaid覆盖的是穷人美国约有四千五百万人（15%）没有医疗保险美国的医疗卫生体系 不足之处Source: OECD dataUSA Total National Health Expenditure

10、s Per CapitaSource: OECD data美国历年人均的医疗费用支出 （单位：美元）Out-of pocket payments, Per capita US$ PPPSource: OECD data美国历年人均的个人自付（单位：美元）Source: OECD data* Includes programmes such as workers compensation, public health activities, Department of Defense, Department of Veterans Affairs, Indian health services,

11、 and state and local hospital and school health* Includes Industrial inplant, privately funded constructions, and non-patient revenues including philanthropySource: Health Care Administration, Office of Actuary, National Statistic Group, 1999Health Costs Breakdown 1998 - Where it came from* 包括工人赔偿，公

12、共健康活动，防卫部门，老兵事务部门，印地安人健康服务，州立及地方的医院及学校医疗的一系列方案* 包括产业注入，私人集资的建设以及来自慈善事业的非患者收入Source: Health Care Administration, Office of Actuary, National Statistic Group, 19991998年美国医疗卫生成本分析 资金来源Health Costs Breakdown 1998 - Where it went1998年美国医疗卫生成本分析 资金使用流向Key Participants in the Health Care System美国医疗卫生体系的主要参

13、与者19972000IndividualsIn $ Billions; percent $1,118.1*1,223.9*19972000EmployersFundingIndividualsEmployersIndemnity plansManaged careProviders$1,118.1*1,223.9*Risk held100% =100% =GovernmentGovernment2005*2005*1,790.7*1,790.7*40.0%36.7%* EstimatesInsurersRoughly $500 billion in health insurance premi

14、um in 2001.Risk Distribution In U.S. Health Care Industry 19972000个人（单位：十亿美元；百分比） $1,118.1*1,223.9*19972000雇主资金来源个人雇主赔偿计划管理式医疗医疗服务提供者$1,118.1*1,223.9*风险承担100% =100% =政府政府2005*2005*1,790.7*1,790.7*31.8%35.8%19.4%21.7%40.0%42.4%10.1%5.4%15.5%16.1%7.4%8.6%13.3%14.3%17.1%19.2%36.7%36.4%* 估计值40.6%22.7%36

15、.7%36.7%20.1%14.5%8.9%17.5%保险公司2001年健康险保费约为五千亿美元美国医疗卫生业的风险分布Consumer empowermentSure bet trendsRising pharmaceutical costsAging populationPatients become more involved in health care related decision making and demand informationPotential outcomeDrug costs will likely grow from 9% to 14% of total U.

16、S. national health care expendituresAdditional health care-related costs of over $40billionConsumers demandMore health informationHigher transparency More tailored care servicesGreater decision making powerDescriptionNew drugs - 17% increase in annual launches over the next 5 yearsMore tailored drug

17、sDTC advertisingAn incremental 8 million 65+ people expected in 2001-06Over 65 population demands specialized health care products/services (e.g., chronic care, terminal illness)Primary Insurers Are going to come under profit pressures due to three sure trends消费者授权必然趋势上升的医药成本人口老化患者被更多地卷入到与医疗卫生相关的决策与

18、信息需求中潜在影响结果药品成本占美国医疗卫生支出的比例可能将从9%增长到14%附加的与医疗卫生相关的成本将超过四百亿美元消费者需要更多的医疗信息更高的透明度更多的针对性强的服务更大的决策力描述在今后5年中新药将以每年17%的递增速度向市场投放更多有针对性的药品DTC 广告预计2001-2006年65岁以上人群将增长八百万65岁以上人群需要特殊的医疗卫生产品与服务（如疾病晚期慢性、长期护理）由于三种必然趋势直保公司正日益面临赢利压力Shifting health care benefit responsibilitiesWild card trendsPotential solutions fo

19、r the uninsuredPotential outcomeDefined contribution, a new health benefit financing tool, that transfers control to consumers and limits benefit costs for employersNew models developed to offer coverage to new market of uninsuredDescriptionEmployers face significant medical costsEmployers seek to shift some portion of health care costs to employeesEmployees demand more control of hea