The ability is still weak. In 2018, China’s health insurance business indemnity and payment of 174.434 billion yuan, an increase of 34.72%, equivalent to the total expenditure of the basic medical insurance fund (1.78 trillion) 10% is equivalent to 3% of total health expenditure (5799.83 billion yuan).
So, is the current TPA fever going to be the beginning of a new, powerful payment party?
This in turn depends on a question: Is the TPA fever a real market demand or a bubble in the capital market?
What we can see is that TPA has slowly upgraded itself from being a “dirty” and “tired” outsourcer to a service provider that can provide core competitiveness to health insurance companies. These new TPA companies emphasize that the services they provide are “not worthwhile value-added services”.
The entrepreneurs who are involved in it are optimistic about this industry. In an interview with the Arterial Network, a company executive considered the potential market size of the health insurance TPA to exceed 100 billion. Her judgment is based on the “Health Insurance Management Measures (Draft for Comment) issued by the China Insurance Regulatory Commission in 2017. The document mentions the health management of insurance companies. The cost of service sharing cannot exceed 20% of the net insurance premium. If the health insurance income exceeds 1 trillion, it is possible for TPA to share 100 billion cakes.
Jiang Champion agrees with TPA’s irreplaceability, medical and insurance are relatively independent, so “TPA companies that are familiar with both industries can recognize the pain points of the industry and seize the market opportunities.”
According to Jiang Ching’s observation, with the rapid expansion of the health insurance market and the industry’s demand for refined management of health insurance, some insurance companies need third-party management teams to provide some professional skills support. These required skills span the entire value chain, including product development, risk control, marketing, and subsequent claims processing.
However, for TPA’s profit model for health services, Jiang Chung believes that these new businesses are still in the early stages of the country and there is not enough data to quantify the results.
Song Qingyong also believes in the value of TPA. “Insurance is a connector that connects medical services, pharmaceutical devices, and health care. To achieve these connections depends on different TPAs.” But he also believes that TPA itself is not a profiteering industry, and now it is a bit of a bubble. “Like the health tube I saw.