What Is a Third-Party Administrator?

Third Party Management TPA (Third Party Administrator), which is a third-party administrator, belongs to the industry concept in the international medical insurance claim system.

Third party management

Third Party Management TPA (Third Party Administrator)

It originated from

Third-party management TPA has a stronger third-party service provider character than traditional insurance intermediariesbrokers, agents, and assessors. It is independent of the supply and demand sides, and has no direct upstream and downstream value relationship and organizational direct relationship with the insurer and the insured. Because of this third-party nature between the insurer and the insured, it determines the necessary conditions for the survival and development of TPA:

1. Professionalism, that is, not only to provide professional services, but also to provide services in areas that exceed the supply and demand sides of insurance;

2. Contractuality, that is, the third-party relationship is protected and restricted by legal norms, and TPA and the service recipient work together within the framework of the contract;

3. Value-added is the core of TPA's business, that is, the value-added of the service recipient must be realized at every step of contract performance.

These unique characteristics of TPA also ensure its huge advantages in the health insurance market.

In some developed countries, third-party management has become a more mature and practical risk management service. In the health insurance market, it has become an indispensable and important part. But domestically, despite so many benefits, TPA always seems to have obstacles in the process of "Sinification".

The root cause of the slow and embarrassing situation in China is that the current status of the domestic medical system is quite different from that of foreign countries. First, the status of public hospitals is strong, and there is a large information asymmetry between hospitals and medical insurance companies, and a unified information platform cannot be established uniformly. Second, medical fees vary, and a comprehensive and accurate fee accounting system has not yet been established in China. Insurance companies are unable to establish standards for assessing patients' medical expenses. Third, as a new type of insurance intermediary business, it is still innovative, and there are blanks in legal and regulatory systems, which can only be registered in the form of consulting companies and management companies.

Despite so many obstacles in reality, the continued development of TPA in China's health insurance market is promising and advantageous. Among domestic companies dedicated to TPA services, the Yuean Kangjian Rescue Alliance with a foreign background allows us to see the hope of the development of domestic TPA. The advantages of the third-party management mode are shown in the following aspects:

1. Cooperate with government medical institutions to obtain medical resources. It cooperates with the Chinese Hospital Association and has an emergency rescue network platform covering the whole country. The national medical resource network built on the platform has great scalability, which can effectively coordinate and manage medical institutions, provide standard third-party medical services for customers such as insurance companies, and achieve product optimization, cost savings and service value-added. .

2. Position high-end customers and cultivate core advantages. It will provide emergency rescue and related medical services to customers, members of insurance companies, banks and other financial institutions, and members of large groups of users, ensuring business stability and high profit growth, thereby continuing to develop to low-end customers.

Relying on large insurance companies, develop value-added service policies, design humanized emergency rescue services and other medical consulting services to enhance the value of the policies, so as to achieve a win-win situation for both parties.

Fourth, the use of large-scale activities to enhance the influence of the industry. As a new type of insurance service business, TPA has a low level of awareness. After the launch of the Yuean Rescue Alliance program, it actively used various major international events to not only achieve its own business growth, but more importantly, to enhance the public's awareness of TPA to a certain extent, and to make insurance customers experience a high TPA The level of medical insurance services has laid the foundation for further market development.

With the deepening of China's insurance industry opening up to the outside world and the intensification of competition in the domestic industry, local insurance companies must accelerate the consolidation of core business advantages and vigorously improve the quality of insurance services in order to cultivate stronger competitive advantages to meet future challenges and opportunities. This trend also requires insurance companies to outsource non-core businesses, which is precisely the development trend of the international insurance industry. As a professional service provider that handles all matters in the process of claim settlement for the insured company, TPA carries the mission of promoting the development of the insurance health insurance market. It is believed that the snowdrops on this iceberg will spread perfectly on the insurance mountain in China.