Yi Chang, Hubei Province, China — At an unprecedented meeting of Chinese and American insurance regulators and university folks here in the Three Gorges region this week, participants are sharing ideas across a substantial cultural divide on the possible directions for the development of private health insurance in China and the various regulatory strategies for managing this emerging market place. The knowledge demonstrated by the Chinese officials of the American health insurance system — both its achievements and problems such as the uninsured — is quite impressive. They are also genuinely forthcoming on the issues they confront everyday in a system which suffers from very limited coverage, poor cost control and low operational efficiency as well as a number of other problems.

So the discussions are approaching the ‘reality zone’ rather than simply an exchange of cross-national niceties. The Chinese want to grow private health insurance both as a way to supplement current government social insurance programs, and as a mechanism to introduce innovation and improve quality in China’s health care delivery system. Consequently they are in an experimental and ‘pilot project’ frame of mind when it comes to listening to various aspects of the American experience. For example, substantial discussion today focused on the role of taxation on the development the health insurance market, different provider delivery models — PPOs, HMOs etc. — and building in professionalism into the industry.

An interesting presentation described one of these experimental efforts in Xiamen, China. Referred to as the “Xiamen Model”, this approach to supplementing government social insurance, which has evolved over the the past few years, involves private insurers in a unique Third Party Administration (TPA) role that includes some risk sharing along with public-private co-management arrangements. Interesting to say the least and revealing of the unusual thinking now taking place as the country explores the future of health care reform.