Insurance and Health Management: The Application of Insurance in the Health Management Industry - Exemplified by Kaiser Permanente in the United States and Ping An Insurance in China

In recent years, China’s aging population has become a heavier burden of chronic diseases. China has actively promoted the elderly service system toward a high level of development. The dual pressure of escalating health demand and the mismatch of medical resources has accelerated the change of insurance products and health protection models. This paper compares and contrasts the application of insurance in the health management industry through case studies. It summarizes the successful commercialization model of Kaiser Permanente’s “insurance + health management” synergistic development, which adopts a prepaid system and medical risk co-payment, coupled with strong investment in health information technology and strict control of medical costs; its costs are lower than the industry average. Ping An of China, on the other hand, has created a more extended “insurance + service” ecosystem model. Technology-enabled service upgrading utilizes AI and big data to build claims and health management platforms; the whole life cycle health management closed loop greatly improves work efficiency. Both reflect the general trend of insurance transforming from a pure risk compensator to a health manager and technology-enabled transformation. This research contributes to filling the interdisciplinary research gap on health management and insurance and exploring health management services. In terms of social public services, it can promote the realization of the goal of benefiting people’s health, reducing costs, and improving efficiency.