Intelligent data empowerment for healthcare, collaborative protection of people's livelihood. China Life Guangzhou Branch creates a new model of multi-level medical security collaborative development.

(Source: Guangzhou Finance)

Medical security is the foundation of people’s livelihood and a solid support for citizens’ happy lives. As China’s population aging process accelerates, the public’s demand for diversified and personalized national health protection continues to upgrade, while the traditional medical security system still faces many urgent practical bottlenecks in cross-departmental coordination, service efficiency, and inclusive service quality. Against this background, China Life Guangzhou Branch, in collaboration with multiple parties, has created a multi-level medical security system and a precise empowerment and coordination platform. The platform centers on intelligent digital technology, breaking down data barriers across various sectors, deeply integrating high-quality protection resources, and building a new smart medical insurance ecosystem led by the government, involving market participation and social collaboration. It aims to explore a practical, replicable, and scalable path in Guangzhou to address regional medical insurance development challenges and improve the quality of people’s livelihood protection.

Targeting core industry pain points, strengthening the foundation of livelihood security

Currently, China has established a “1+3+N” multi-level medical security framework, but in the actual implementation process, a series of bottlenecks restrict the full release of overall protection effectiveness. Among them, data silos are particularly prominent; data across departments such as medical insurance, health, civil affairs, and commercial insurance have not achieved efficient interconnection. To some extent, this results in a lack of precise data support for commercial insurance product design, with industry products showing high homogeneity—80% of products are concentrated in million-dollar medical insurance—while protection for special groups such as the chronically ill and the elderly needs strengthening. The closed loop of “high risk → high premium → low participation” cannot fully match the diverse protection needs of various groups, hindering the balanced development of the multi-level medical security system.

Meanwhile, the service experience of medical reimbursement for the public also has room for optimization. Under traditional models, many citizens face high medical advance payment pressure, cumbersome claims processes, and relatively long processing cycles; vulnerable groups like the elderly also encounter difficulties operating online services or having to visit multiple offline service windows. Additionally, the level of intelligent regulation of medical insurance funds needs improvement. Traditional commercial insurance risk control still relies on manual review, which is not conducive to the efficient and standardized operation of funds and poses higher challenges to the long-term stable and sustainable development of medical insurance funds.

In response to the core shortcomings and public concerns during the implementation of the multi-level medical insurance system, China Life Guangzhou Branch fully leverages its core advantages in insurance and its extensive service network, closely following national medical insurance reform deployment and local livelihood protection requirements. It has led the construction of a specialized coordination platform, using digital intelligence methods to break service bottlenecks and address system construction gaps, injecting strong momentum into the high-quality development of Guangzhou’s medical security industry.

Strong support from digital intelligence architecture, building a full-chain coordination system

The platform is based on practical needs, supported by new-generation information technologies such as artificial intelligence, cloud computing, big data, and privacy computing. It innovatively constructs a “three-horizontal, four-vertical” digital intelligence architecture, achieving full coverage of protection areas, seamless service processes, and comprehensive governance collaboration, thoroughly breaking the fragmentation dilemma of traditional medical insurance services.

The “three-horizontal” collaboration breaks through, connecting the four major sectors of basic medical insurance, serious illness insurance, medical assistance, and commercial health insurance horizontally, realizing automatic linkage of various protection benefits and integrated medical expense accounting, fully solving issues like multiple reimbursements and repeated submission of materials; the “four-vertical” closed loop improves efficiency, vertically connecting four core modules: data collection, intelligent analysis, business coordination, and service delivery, forming a full closed-loop high-efficiency operation mode from data aggregation to service implementation, eliminating process gaps.

In terms of technical security, the platform strictly follows the national third-level information security protection standards, adopts a high-standard five-layer technical architecture, with a core business availability of no less than 99.99%, sensitive data stored with full encryption, and core business response times within 2 seconds. It balances data security and operational efficiency, building a solid digital intelligence security line for medical insurance.

Three major innovative breakthroughs activate new vitality in the medical insurance ecosystem

The core value of the platform lies in innovative solutions to pain points and empowering livelihood through practical efforts. Under the full promotion of China Life Guangzhou Branch, the platform has achieved key breakthroughs in product design, risk control, and ecological collaboration, comprehensively promoting the transformation and upgrading of Guangzhou’s medical security system.

First, product design innovation, breaking homogenization, achieving “tailored policies for thousands of people.” Relying on multi-source data fusion technology, the platform builds a detailed database of users’ health risks and protection needs, using AI models to perform precise stratification analysis of groups with different ages, health conditions, and protection demands. It then customizes suitable commercial health insurance products to fill gaps beyond basic medical insurance, effectively optimizing the supply structure of commercial insurance products, solving the industry’s homogenization problem, and making protection more aligned with the actual needs of the public.

Second, risk control innovation, intelligent risk prevention, strengthening the safety barrier of funds. The platform constructs a full-process intelligent risk control system, enabling rapid response and handling of high-risk events within one minute, and opening cross-departmental regulatory channels. It enhances the linkage and joint regulation of medical insurance funds and commercial insurance funds, establishing a working mechanism for collaborative prevention and control, comprehensively strengthening the normative management of protection funds throughout the process, improving risk control accuracy, and helping to improve the quality and efficiency of medical insurance funds’ operation.

Third, ecological collaboration innovation, multi-party efforts, building a win-win new pattern. The platform deeply promotes the integration and coordinated efforts of government, medical institutions, insurance companies, enterprises, and society. China Life Guangzhou Branch leverages its professional insurance advantages to support the precise implementation of medical insurance policies, accelerate medical institution reimbursements, and continuously optimize public protection services, forming a positive ecological cycle of mutual benefit. Taking Guangzhou’s “Sui Sui Kang” inclusive insurance as an example, the project relies on the platform’s digital empowerment, significantly improving product protection accuracy and service efficiency. In June 2024, the company’s case “Deepening the ‘Silver Age Health Action’ and Promoting ‘Sui Sui Kang’ Guangzhou-specific Inclusive Insurance” was successfully included in Guangzhou’s inclusive finance promotion cases, fully demonstrating the platform’s practical and social value.

Significant livelihood benefits, making medical insurance services warmer

Since its implementation, the platform has adhered to the people-centered development philosophy, achieving multiple value wins in livelihood security, industry development, and social governance, allowing the benefits of digital intelligence medical insurance to truly reach thousands of households.

For the public, it is more convenient and reassuring. Fully realizing one-stop settlement and seamless, quick claims for basic medical insurance, commercial health insurance, and medical assistance, reducing the claims cycle from 5–7 days to within 10 seconds, effectively alleviating the pressure of advance medical payments; optimizing service processes for vulnerable groups like the elderly, solving operational difficulties, and improving protection accessibility, making medical insurance services warmer.

For the industry, quality improvement and efficiency enhancement, more stable development. Effectively improving the full-process service efficiency of underwriting and claims in commercial insurance, promoting the transformation of the commercial health insurance industry from “scale expansion” to “high-quality development”; assisting in modernizing medical insurance governance systems and capabilities, fostering coordinated and healthy development of medical insurance and commercial insurance, and promoting overall industry quality and upgrade.

For society, empowering the health industry and supporting Healthy China construction. The platform deeply activates the regional health industry ecosystem, promoting the deep integration of medical security and health management services, gradually forming a virtuous cycle of “protection promotes health, health reduces burdens,” providing strong support for healthy Guangzhou and Healthy China.

Deepening livelihood protection, painting a new picture of multi-level medical insurance

The multi-level medical security system’s precise empowerment and coordination platform is an innovative practice of deep integration between digital intelligence technology and livelihood protection. It also vividly reflects China Life Guangzhou Branch’s mission as a state-owned insurance enterprise serving the people, providing valuable experience for the construction of nationwide multi-level medical security systems that can be learned from and replicated.

Looking ahead, China Life Guangzhou Branch will continue to uphold the original aspiration of “serving the country through finance, insurance for the people,” deepen the application of digital intelligence technology, optimize functional architecture, strengthen multi-party collaboration, further enrich exclusive commercial insurance products, expand coverage, and improve service quality. Meanwhile, it will actively promote the platform’s mature practical experience across regions and scenarios, breaking down geographical and industry barriers, so that the benefits of digital intelligence medical insurance can reach more people. It will strive to build a coordinated, efficient, inclusive, and powerful multi-level medical security system, firmly safeguarding the health and lives of the people and strengthening the solid foundation of livelihood security.