Private-sector opportunities in Chinese healthcare

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Written By DerrickCalvert

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China’s central government last year announced a series health care reforms in response to social pressures. The central government’s ambitious goals include establishing a universal, basic health care system that provides safe, efficient, convenient, low-cost, and affordable services for all the country’s more then 1.3 billion residents. These reforms will affect all aspects of health care delivery including primary care management, insurance, and medications.

These reforms, along with the $125 billion that the government has pledged to support them, will likely improve the quality of care for Chinese citizens and increase their health outcomes. They will stimulate health insurance for foreigners in China market and provide opportunities for providers and private payers.

We estimate that the market is worth $240 billion. This represents about 5 percent of China’s GDP. It could reach $600 billion in ten years. It will reach $480 billion if China’s health spending keeps up with its projected GDP growth. However, we believe it will rise faster than GDP due to better insurance coverage, access to high-quality healthcare, and rising demand (related to aging, urbanization and lifestyle changes). The market could grow by $150 billion if health care spending reaches 6.5 percent of GDP by 2018.

The primary goal of the reforms is to provide universal access to basic health services. This will ensure that the government continues to be the dominant market player, particularly from a delivery perspective. The changes make it easier for private companies to join the market by clarifying the roles of public payers and providers, identifying niches for them, and making the operating environment transparenter and more fair for them.

Payers have many options

Private health insurance is a minor part of China’s market, but it is still significant, considering China’s population. In 2008, the premiums reached $8.4 Billion. If this spending increases at the same rate as we expect and the role of the private sector in health insurance grows, the market could reach $90billion by 2020.

Private payers have the best options for program management and supplemental coverage. Many Chinese consumers may find additional products that provide supplementary coverage attractive, as the level of coverage offered by public insurance programs will vary widely between different types of insurance and across geographic regions. For example, a product that is tailored to the large population could provide safety net coverage such as reimbursement beyond annual limits. A company could also target wealthy consumers by offering a more complete offer that includes access to top-end hospitals and other services.

Local governments have the opportunity to work with private payers to manage public insurance programs. Some cities and regions have started to partner with private companies in order to tap their expertise in areas such as provider management, enrollment, benefit design, and enrollment. These governments can benefit from the expertise of private companies to help them develop customer insight, optimize product design, and track subscriber data better. In addition, they can show governments how to accelerate the adoption of standard treatment protocols, install performance-monitoring mechanisms, and minimize variations in treatment costs.

To take advantage of these opportunities, a few foreign payers are now entering China’s market. Discovery Holdings, a South African-based health insurance company, acquired a small share in Ping An Health Insurance in 2009. This is one of the largest private Chinese health insurers. WellPoint is also taking the plunge into China’s payer market.