Assessment of the Risks and Health Control in a Planned...

Assessment of the Risks and Health Control in a Planned Way
HUANG Ying1, SHEN Fei 2
1. School of Economics, University of Jinan, Shandong, China, 250022
2. The Social Research Institute of Jinan, Shandong, China, 250002
[email protected]
：
Abstract In health insurance business, the health management function is different from the medical
service provider of services and management. It is mainly embodies the basic risk management
efficiency. Combining the risk control and health management, to improve the traditional management
ideas, innovation mode of commercial health insurance, improve service levels and benefits.
Keywords health control, assessment of the risks, health management, health care plan
：
1. Introduction
1.1 Demand
As early as age 60 in the last century, the developed countries regarded health control as an
indispensable part in medical service system, such as U.S.A., Germany, Britain, Canada, Finland, Japan,
etc. have already set up multi-form health management organization progressively. At the same time, the
decision members of enterprises realize that the relationship of the staff's health concerns benefit and
development of enterprises directly, thus they regarded the health control as a real medical treatment and
health care consumption strategy for the first time. But for now, the health management systems of
various countries still have many defects. In the United Kingdom, for example, with the improvement of
the aging intensity, people's body constitution has constant downward trends, and the existing health
management system can't be served effectively in time in practice.
In 2008, one report “Food: Analysis of Relevant Questions” published by the Government in the UK
have shown that, the obesity problem of UK troubling. “THE DATA SHOW 28% population is
overweight at present, may reach 60% by 2050; In addition, in 40 years, children's fat phenomenon will
be more serious, 70% of the girls and 55% of the boy's weight will exceed standard or suffer from
obesity.” 1
“People in the UK eat on average 20% more saturated fat than the recommended maximum. Over time,
a diet high in saturated fat can raise cholesterol levels in the blood, which is a risk factor for heart and
circulatory diseases such as coronary heart disease, heart attacks, angina and stroke, and cardiovascular
disease (CVD). CVD is the most common cause of death in the UK and in 2006 was responsible for
about one in three premature deaths.”2
Scientists studied over 32,000 individuals to examine the relationship between different adiposity
measures and the risk of subsequent primary knee and hip joint replacement.
Body Mass Index (BMI), waist circumference and waist-to-hip ratios were all measured, while fat mass
and percentage fat were estimated.
The study determined that there was a three to four-fold increased risk of primary joint replacement
associated with body weight, BMI, fat mass and percentage fat.3
From these, planned health management is very valuable.
1.2 Benefit
Institute for Health and Productivity Management IHPM have ever had penetrating argumentation:
"The integration of health and production efficiency management concerns the staff's health, then
（
1
）
The information comes from: (The British government survey: seven million deaths every year can reduce, if the
British food more health than now), http://www.sina.com.cn, January 23, 2008, Economic Information Daily
2
Saturated fat campaign launched to tackle UK’s biggest killer, Tuesday 10 February 2009,
http://www.food.gov.uk/news/newsarchive/2009/feb/satfatcamp
3
Being overweight increases risk of knee replacement, 05 March 2009, The Health and Safety People Ltd.
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influence data and service of their working performances. It not only measures the influence of the
intervening measure healthy to the staff but also measure the impact on enterprise's production
efficiency of the intervening measure. "
2. Instruction
“Every individual . . . neither intends to promote the public interest, nor knows how much he is
promoting it. . . . He intends only his own gain, and he is in this, as in many other cases, led by an
invisible hand to promote an end which was no part of his intention. Nor is it always the worse for the
society that it was no part of it.”4 By pursuing his own interest he frequently promotes that of the
society more effectually than when he really intends to promote it.
2.1 Health Management
In the sixties of the 20th century, the insurance of U.S.A. put forward the concept of the health control at
first. It is defined as the whole course of monitoring, analyzing, assessing, predicting and preventing in
jeopardizing various healthy factors of individual or crowd. Its aim is to arouse individual and collective
enthusiasm, thus make use of limited resource to reach the greatest health and improve the result
effectively. As a kind of service, it appraises personal health status, offers the health of pertinence to
guide, make them take action to improve the health. Its key content includes: Collect health information,
set up health file, assessment and predict that moves towards, makes and implements the health plan in
health, follow-up is healthy.
The health control conducts a healthy life style, make the passive health care turn into the initiative
health control, protect and promote human health more effectively. The health control is a kind of
concept, and a method, is a complete service routine even more.
2.2 Risk Assessment
Risk assessment is the process of estimating the potential impact of a hazard (such as a chemical) on a
specified population under a particular set of conditions and for a certain timeframe. Classical risk
assessment is based upon 4 stages, namely hazard identification, hazard characterization, exposure
assessment and risk characterization.
Risk assessment is also intended to provide information to all parties concerned so that the best possible
decisions are made. However, there are uncertainties related to risk assessment and it is important to
make best possible use of available information.
Table1. Risk Matrix
Example: Impact of chemical incident is High (3) and the probability is extremely Low (1) then the
overall risk is 3 * 1 = 3. If the impact of it raining is also high (3) and the probability is high (3) then the
overall risk is 3 * 3 = 9. It makes sense to worry more about the raining, which is a much bigger risk.
The goal of risk management is to provide service for business, it is the insurance taken corresponding
measures for corporate benefit. Because of the particularity of the health insurance, once risk
management combines the health control, having changed the mode only paying attention to internal
management, the health control can be extended to sale, and will manage the content and run through
the whole course offered in medical care. Make the utilization efficiency of the expenses maximize,
4
Adam Smith, (1776) An Inquiry into the Nature and Causes of the Wealth of Nations
373
realize the goal of the insurer's interests.
3. Rationale
U.S.A. draws the following conclusion through the research of more than 20 years: 10% of the
individuals and enterprises have not participated in the health control, the hospitalization cost rises by
90% than before; 90% of the individuals and enterprises are through after the health control, the
hospitalization cost drops to original 10%. Already there is a cost accounting that generally admits in the
developed country: Invest in 1 yean of health control, can be reduced on the hospitalization cost by 8-9
yean in the future.
Risk Assessment: Issues to consider may include:
Risks at a certain point in time as well as changes in risk over time
The use of Health Guidance Values (the level of the chemical, for example in air or water, to which
people may be exposed without appreciable adverse health risk) which will adequately protect public
health
Assessments of new types of risk
Assessments of different types of risk
densification and comparison of different factors that affect the nature and magnitude of the risk
Ranking issues according to their level of risks
Provide a clearly documented and open process
U.S.A. draws the following conclusion through the research of more than 20 years: 10% of the
individuals and enterprises have not participated in the health control, the hospitalization cost rises by
90% than before; 90% of the individuals and enterprises are through after the health control, the
hospitalization cost drops to original 10%. Already there is a cost accounting that generally admits in the
developed country: Invest in 1 Yuan of health control, can be reduced on the hospitalization cost by 8-9
Yuan in the future.
Conclusion: Planned health management can effectively reduce the individual's health risks.
4. Research Objectives
(1)Assessment of the risk and planned health control can be applied to the health insurance trade
The health control is applied to insurance trade, can control the health risk of crowd insuring, and
predict the health fee which insures the crowd more effectively.
The health control meets customer's health service's demands through offering specialization,
individualized health management service;
Can reduce the loss ratio of the insurance company; expand space of profit, through the specialized risk
control of making a diagnosis of health.
(2)Assessment of the risk and planned health control can provide assistance in the following three points
to the community service:
First: Discern, control the dangerous factor of the health, and implement the individualized health
education;
Second: Guide medical demand and service, assist clinical decision;
Third: Realize the information management of whole health.
(3) The function of the government: Guide, supervise the development of the health control trade.
First: Issue and improve the relevant policies, laws and regulations of health control trade, purify and
foster the market environment, standardize market behavior;
Second: Put up the national-level health control scientific research institution and academic
organization;
Third: Set up trade learning and association, guidance and standardizing the health control
Fourth: Standardize talent training, implement the market access
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5. Conclusion
：
New methods and new ways in combination with the risk control and health management
Firstly, the mode of operation can implement management style. For example, on one hand operation
commercial health insurance, on the other hand by the gp whole health management.
Secondly, the underwriter established corresponding customer complaint mechanism, supervision and
management of customer enjoy all-around doctor of medical service quality and the management level.
Once the service standard, service content, service form accurately convenient, can achieve higher rate,
reduce the precautionary health care and hospital admission rates and reduce the cost of medical
treatment cost, reasonable use of waste of medical service, etc.
Anyhow, the risk control and health management combination, can effectively improve the past tradition
realization management thought, commercial health insurance pattern of innovation and improvement of
service level, and improve efficiency.
Author in brief:
Huang Ying (1963-),Female, the people of Qingjiang in Jiangxi, director of the regional institute for
economic research of university of Jinan, the master of economics, associate professor, the Master
degree candidate's tutor, research field: Regional economic research.
Contact information:
Phone number: 0531-86865230
Email address: [email protected], [email protected]
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