Health and Life Insurance in China

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1 Business Perspective Health and Life Insurance in China Thierry JEANTET Under the supervision of Patrick Bacchetta Thesis to complete studies at Enass, Institut du Cnam, 2012

2 Foreword Thierry Jeantet was already very busy with his studies at Enass and his valuable contribution to innovation and the creation of the health and life insurance service of La Banque Postale Prévoyance, where I was Chief Executive Officer, when he asked for my support on his project, aimed at improving his outlook and understanding of personal insurance through his analysis of the Outlook for Health and Life Insurance in China. Together we discussed the difficulties of such an undertaking, both from a practical and technical point of view, but nothing could weaken Thierry s resolve. After spending a few weeks in China, followed by several months of analysis, his work is now a valuable tool to improve our understanding of the Chinese insurance market, its vast prospects, but also the difficulties faced by foreign players who are attempting to establish a base with mixed results. We learn, for example, that the market capitalisation of each of the main two players in Chinese insurance, China Life and Ping An, exceeds that of Allianz, that in a market which has already recorded USD 215 billion in premiums, the average annual growth rate is 20% and that by 2014, the number of life insurance policies will rise by 70%. Nonetheless, Sino-Foreign joint ventures are still far from breaking even and at the time of writing, HSBC has announced the sale of its 15.6% stake in Ping An, valued at almost USD 10 billion. Beyond his analysis and observations, Thierry Jeantet suggests original strategic routes to derive tangible profits from having a presence in China. Faced with the accelerated disruption of global equilibrium, the perceptions of a young, open mind are key to enhancing our understanding and building our vision. There is not only exponential growth, but also maturity in expertise and economic fundamentals. The Chinese paradox is so powerful that this market must be approached unlike any other and certainly not like that of an emerging country. The break from the past is brutal and relationships are reversed; did you know that Ping An, the second largest shareholder in Belgian-Dutch bank Fortis, is suing the Belgian government to recoup the 3 billion that it had invested in 2007 before a solution was found with BNP to bailout Fortis? Therefore, it is with great pleasure that I once again welcome Thierry Jeantet, who has recently completed his studies and joined s insurance teams. Patrick Bacchetta

3 Summary The People s Republic of China boasts an unparalleled growth outlook worldwide. The insurance sector is no exception and offers vast opportunities. Among these, health and life insurance still appears to be a limited market that is set to expand. Foreign insurers currently operating in the Chinese insurance market are faced with major constraints. Their financial position, issues stemming from difficult relationships with the government and their operational weaknesses call their presence in China greatly into question. Furthermore, legal restrictions on the creation of a life insurance company by a foreign insurer pose limitations which put the status of the latter at a disadvantage. Nevertheless, positive developments seem to present certain opportunities. Growth in premiums collected now also profits foreign insurers and regulatory hurdles are being questioned. This favourable outlook hails the advent of a new form of strategy for foreign companies operating in this market. The latter position themselves by adopting innovative partnership strategies in the hope of increasing performance. Health and life insurance is one of the markets likely to benefit foreign insurers. Here again the situation is antinomic and has its limitations and opportunities in equal measure. An analysis of the current situation does help determine the major deficiencies in terms of care and social protection services, yet the efforts and work undertaken by the government allow us to envisage an improvement in this sector in the medium-term. Health and life insurance is directly related to the quality of the health sector and government intervention which has a duty to lay the necessary foundations to mitigate this risk. Therefore, foreign insurers will be able to anticipate the opening of new markets for health and life insurance. The marketing of such a range of products must however provide for a process that is clearly defined and adapted to the challenges and objectives envisaged. The nature of the distribution network is the first key element of this process. Experience has shown the financial difficulties of maintaining a network of agents. Conversely, banking networks seem to provide a solution to anticipated financial and operational issues. In addition, alternative and partnership strategies help to increase production capacity when a very committed banking player is involved. Finally, the range of services must respond to crucial contextual factors. The typology of cultures, expectations and both geographical and occupational targeting must allow us to ascertain needs and tailor health and life insurance products accordingly. Outlook for health and life insurance in China for use by foreign insurers Page 2

4 Acknowledgements I wish to thank those without whom this unique experience could never have happened. First of all, I would like to thank Patrick Bacchetta () without whom this study would not have benefited from the wealth of information it contains and the response it has received. I would also like to thank the entire teaching and technical staff at the Ecole Nationale d Assurances (National French School of Insurance), chaired by François Ewald. Their training helped me to progress rapidly in the world of insurance. Thank you to all the teachers, the entire administrative team for their availability and their support, as well as to Marc Philippe Juilliard for the relevance of his techniques. I would also like to thank Pierre-Nicolas Carissan (CNP), Sophie Arribehaute (CNP) and Bin Gao (AXA) for helping me achieve an understanding of this market and for providing me with the opportunity to meet important contacts during my time in Beijing. I also wish to thank my foreign contacts who provided valuable information relating to their local experience, as well as their warm welcome in China: - Christian Bishop (Sino French Life Insurance) - Maxime Finet (Sino French Life Insurance) - Frank Van Caenegem (Sino French Life Insurance) - Kevin Gongye (Axa Minmetals) - Xin Tong (Axa Minmetals) - Allen Zou (Axa Minmetals) - Jean Liu (Axa Minmetals) - Guo Yongping (AXA Beijing Representative Office) Finally, I would like to especially thank La Banque Postale Prévoyance for their warm welcome and for helping me discover the world of Health and Life Insurance. Outlook for health and life insurance in China for use by foreign insurers Page 3

5 Contents SUMMARY 2 CONTENTS 4 INTRODUCTION 6 1. The health and life insurance market in China: opportunities Outlook for the insurance market in China Fundamentals of the market Global positioning Quantitative outlook Coverage of health and life risks Development of social protection, a favourable ground Needs relating to disparities and inequalities in the systems The outlook for establishing bases Outlook for the development of households Increase in purchasing power Needs growing exponentially Developing awareness of health and life insurance products Challenges for the Health and Life Insurance market in China Challenges for the insurance market Strategic issues Operational and regulatory issues Financial difficulties Absence of a technical framework Issues relating to the structure of healthcare provision Issues relating to healthcare positions Difficulties in establishing private cover Difficulties inherent in the type of expectations Lack of involvement of public authorities Challenges for foreign insurers pioneering innovation Lack of consumer and network interest Development strategies Position of foreign insurers Types of networks The bank insurance model Alternative positioning From the risk to the health and life insurance contract Types of risks 53 Outlook for health and life insurance in China for use by foreign insurers Page 4

6 Health and life insurance contracts Commercial positioning Factors influencing the product range Needs Different populations Product profitability 62 CONCLUSION 63 BIBLIOGRAPHY 64 LIST OF WEBSITES CONSULTED 65 INTERVIEWS 65 KEY TERMS 65 Outlook for health and life insurance in China for use by foreign insurers Page 5

7 Introduction One in six of the world s population is Chinese. The People s Republic of China is a huge country which fascinates as much as it terrifies and with good reason; all the data on this region shows a structure that can challenge all the current major world powers. In addition, the outlook for this nation gives us a sense that this phenomenon will only increase. Whether it terrifies or excites, since 1949, the People s Republic of China has aroused the interest of different global operators and has brought renewed economic vitality to a Western environment where many markets are deemed saturated. The People s Republic of China, which for the purposes of this study will be referred to as simply China, has a centralised organisation which has three official administrative levels, namely, in order of hierarchy, province, county and township. The provincial level is directly linked to the central government and is made up of 22 provinces, 5 autonomous regions (including Tibet), 4 municipalities (including Shanghai and Beijing) and 2 special administrative regions (Hong Kong and Macao). Each provincial level territory has its own strong and distinct identity. The administrative structure in China is pyramidal and modular so that whilst the government sits at the top of the pyramid of each territory, local cultural identity is respected and the organisational structure of each territory is adapted accordingly. Source: Wikimedia Outlook for health and life insurance in China for use by foreign insurers Page 6

8 Breaking completely from the communist economic policy established by Mao, today China only retains communism as its political structure and some of its recurring cultural elements. The Chinese political system features the merger of a single political party and the State. In contrast to the communist model which prescribes that party and State must remain separate and that the former must dictate to the latter, different too from the democratic model where a plurality of parties is put in competition for the public vote and where a party will govern the State for a specified term, the Chinese system only scarcely distinguishes a single party from a State which comprises the same members and operates the country in autarky. The Chinese economic system now wishes to be resolutely liberal and, since its admission to the World Trade Organisation in 2001, has been striving to achieve full integration into the market economy. Following its admission to the WTO, China adopted a number of resolutions to allow foreign companies to set up there and thus be able to take advantage of a country with, for many reasons, the greatest market potential and the best development outlook worldwide. Foreign insurance companies are no exception to this rule and many ventured into this market which boasts such incredible possibilities. There are two types of foreign insurance companies in China (in contrast with local insurance companies). They may be companies that are wholly owned by a non- Chinese parent company (the special administrative regions in China do not fall under Chinese Law), or companies which are co-owned by a Chinese entity and a foreign company that holds over 25% of the capital. Many of these foreign companies have thus seized the opportunity presented by this promising market and set up an office there, under various forms, with ambitious or even disproportionate objectives. However, this market penetration has not proven so fruitful and many foreign players in China s insurance market no longer know which strategy to turn to. They face extremely delicate financial situations and have to deal with partners who have become impatient. To overcome these difficulties, foreign insurers, with strong technical expertise in insurance and indepth knowledge of this sector, could capitalise on new needs in insurance that go hand-in-hand with the rapid development of a middle class in China. Health and life insurance may be defined as personal insurance which covers a risk that may impair the health of the person, whether this risk causes them to incur expenses for healthcare services, incapacity, invalidity, old-age dependency or death, and whether this risk results from an illness or an accident. It covers all insurance categories termed personal insurance in French and life & health insurance in English. Health and life insurance is directly linked to the development of social protection and the healthcare system. Health and life insurance can only be marketed if a social protection system and a healthcare system already exist, and in this sense act as the technical basis for the implementation of a second degree cover as provided by these private entities. Furthermore, health and life insurance can only exist if the social protection system offers partial reimbursement of costs so that payment of the remainder is the responsibility of the individual, which creates the need for second degree insurance. Moreover, independent of the insurance market, today China needs to reform its entire healthcare and social protection system. Due to a situation which has markedly deteriorated since the end of the 20 th century, the State now has the weighty task of re-establishing an affordable, high quality and standardised healthcare system in its vast territory. Social protection is also a major concern to the Chinese since it is now very poorly and only partially provided. In this sense, two distinct challenges make us consider the following issue: what are the challenges for foreign insurers when it comes to health and life insurance in China? First of all, these factors seem to allow us to identify real opportunities for foreign insurers. The development of the insurance market, as well as improvements in the organisation of the healthcare and so- Outlook for health and life insurance in China for use by foreign insurers Page 7

9 cial protection system, means foreign insurers and health and life insurance companies can respectively look forward to a promising future. Secondly, this outlook has been compromised by certain challenges. Although tangible, changes in the insurance market appear to benefit only local insurers and leave foreign insurers in a very delicate position. Moreover, the limitations of China s healthcare and social protection system herald a clear technical and cultural impossibility concerning the implementation of health and life insurance. Finally, following this cross analysis, the methods and options available to design a range of health and life insurance services can be projected, both in terms of products and targeting and of distribution and strategic opportunities. Deng Xiaoping If you open the window for fresh air, you have to expect some flies to blow in Outlook for health and life insurance in China for use by foreign insurers Page 8

10 1. The health and life insurance market in China: opportunities In the next few years, health and life insurance in China will see remarkable, rapid growth, and certainly a development which will be in keeping with the massive scale of this country. The outlook for insurance, coupled with the structuring of the healthcare system and the change in households needs are all factors that demonstrate the significance of this potential Outlook for the insurance market in China Fundamentals of the market The first insurance companies in China As in the vast majority of the world s regions, the development of the shipping trade was the main driver behind the advent of insurance in China. The 19 th century thus saw the emergence of the first form of insurance in China with the creation of the Guangzhou Insurance Office in 1805, an insurance company specialised in cover for maritime risks and created by English merchants to facilitate trade there. The first insurance company, named Eternal Happiness was created in Shanghai in 1846, followed by the creation of the first Chinese insurance company named Ji Ho in 1875, a company specialised in maritime risks. Subsequently, the 1911 revolution ended the Quing dynasty and allowed foreign insurance companies to easily establish themselves in major Chinese cities and American and English insurers had the most significant success throughout the 30s. The insurance sector again found its drive by serving Shanghaibased foreign companies attracted by the expansion of local trade. In 1919, 1935 and 1937, China attempted to regulate the insurance sector by publishing laws on the subject, such as the Chinese Insurance Business Act in 1935 and the Insurance Enterprises Law in 1937; however, none of these regulations were really enforced. The advent of communism Although China had 147 insurance companies in 1946 (136 for non-life insurance, 11 for life insurance), 1949 and the advent of communist China led by Mao Zedong put an end to all aspects of the insurance market in the country. That same year, on 20 October to be precise, the party created the national Chinese company People s Insurance Company of China (PICC), with the purpose of virtually taking over the market. In a State where the citizen has very few personal possessions and where no individual owns real estate, the property insurance market ceased to exist. Besides, since the industry belonged to the nation and the nation was its own insurer, no professional insurance market could survive. The personal insurance market, which had made little headway, was also forgotten amidst the predominance of the social welfare system. In the face of a communist regime, for which insurance was considered a bourgeois entitlement, and for which, according to Jingzhou Tao 1, a simple sentence from Mao is considerably more important than the law, insurance did not survive and the last foreign insurers left in Moreover, the period of the Great Leap Forward instituted by Mao in 1959 led to the suspension of the PICC s insurance activities and its total dissolution within the nationalised system. The PICC then saw practically its entire 1 Le droit chinois contemporain, 1991 Outlook for health and life insurance in China for use by foreign insurers Page 9

11 staff leave and only a few dozen employees were retained to maintain the company s international operations. Prior to his death on 9 September 1976, Mao left his final marks by establishing the period of the socalled Cultural Revolution, during which any imprint of the past had to be destroyed (books, traditional dress, clothes, etc.) in order to modernise the country and revitalise its economy. The rebirth of the insurance market The death of Mao heralded the advent of a new form of economic system in China, and at the end of 1978 the 3 rd plenary session of the communist party launched the first economic reform, to be followed by several others promoted by the leader Deng Xiaoping. In November 1979, the PICC announced that its domestic activities would resume and rapidly increased its workforce from 500 employees in 1979 to 120,000 in The PICC s premium collection very quickly rose to 4.6 million 2 in Life insurance also recovered with an estimated collection of 160,000 in On 21 March 1988, the creation of the company Ping An in Shenzhen heralded the first signs that the market was to reopen by breaking the monopoly then held by the PICC. It was not however until 1992, and the official launch of China in the market economy that the insurance market really re-opened. The shift in 1992 thus allowed the reopening of Shanghai to foreign insurers subject to specific conditions of approval. Foreign insurers had to: have total assets of over USD 5 billion for the year prior to the request for approval, establish a local representative office three years prior to the request, demonstrate 30 years of experience in insurance. American International Assurance (AIA), a wholly-owned subsidiary of the American group AIG was the first organisation to obtain approval in September This approval however limited its activities to Shanghai. In 1995, the first properly implemented and structuring Chinese law relating to the insurance market was promulgated. This made it mandatory to separate life insurance activities and non-life insurance activities into distinct companies. Companies were however permitted to establish a holding company and subsidiaries. The law also prohibited banks (not industries) from owning insurance companies. Further to this regulatory constraint, the four main historical groups, PICC, FICX, Pacific and Ping An modified their structures. PICC became PICC for non-life insurance business, PICC Re for Reinsurance (renamed China Reinsurance Company in 1999), and China Life for its life insurance business. This initial law was followed by the creation of the regulatory body, the China Regulatory Insurance Commission (CIRC) in Marc Bezançon Intervention du 8 décembre 2011 Pour le CHEA - Perspectives du marché asiatiques Outlook for health and life insurance in China for use by foreign insurers Page 10

12 Membership of the WTO On December 11th 2001, The People s Republic of China again took a major step towards the market economy by joining the World Trade Organization. This membership of the WTO was accompanied by bilateral agreements, mainly Sino American and Sino European, aimed at guaranteeing the opening of the market to foreign companies. The law of December 12th 2001 was also created to complete this opening, stipulating the administrative conditions for insurance companies with foreign capital. According to the WTO, the majority of restrictions had been lifted by the end of This opening was seen as an exceptional opportunity for foreign insurers, who were often confronted with saturated markets in their own countries and saw the prospects offered by a market where the rate of uptake was very low and thus the outlook for growth was exceptional. Hank Greenberg, CEO of AIG said, Imagine the volume of premiums if each Chinese citizen insured themselves for just $ Global positioning Specific features of Chinese market growth China is a particular market since it combines extremely strong growth with a very low penetration rate. Thus, as demonstrated by the graph below, China occupies a very specific position in the Asian market by recording annual growth in excess of 20% for non-life insurance and almost 30% for life insurance between 2001 and This growth came about in a market that is still deemed immature due to its still low penetration rate. This specificity is also striking when this same projection is applied on a worldwide scale where we note the presence of saturated markets experiencing little growth, and whose situations are radically different to the Chinese market. Outlook for health and life insurance in China for use by foreign insurers Page 11

13 China s place in the Asian insurance market Source: PWC, Foreign Insurance Companies in China, December The Chinese market within global markets China today fully asserts its prominent position in the world insurance market. With premiums worth billion in 2010, i.e. 4.9% of global collections, China is the 6 th largest market in the world. China is also the market that has recorded the strongest growth with an increase of 26.2% between 2009 and Chinese players in the world market In the life insurance market, China Life was the largest company in the market in 2010 with a market share of 39.4% for total premiums of RMB billion (15% more than in 2009). In 2009, China Life was the 16 th largest insurer worldwide in terms of premiums collected 4. The two other operators sharing the podium with China Life are not to be outdone, even though their market shares remain far lower: - Second: Ping An Life,, RMB 92.6 billion (29% more than in 2009), 10.24% market share, - Third: New China Life, RMB 91.7 billion (41% more than in 2009), 10.13% market share, In the non-life insurance market, it should first be noted that car insurance makes up 70% of the premiums collected. Here again, the same operator is comfortably in first position with a 42% market share in 2009 and total premiums of RMB 66.9 billion. China Pacific Property Insurance and Ping An Property & Casualty Insurance are ranked second and third respectively with market shares of 11.2% and 10.3% for premiums of RMB billion and RMB billion. 3 A.M. Best research, 2009 data 4 Swiss Re, Sigma n 2/2011 Outlook for health and life insurance in China for use by foreign insurers Page 12

14 Analysis of the market capitalisations of insurance companies around the world helps explain the potential as well as the huge importance attributed by the market to listed Chinese companies. Thus, according to the annual ranking by the Financial Times, China Life and Ping An are the second and third largest insurance companies respectively. The market capitalisation, resulting from the calculation of the number of shares issued multiplied by the share price, demonstrates the trust the market has in these companies and positions them at the top of the global ranking. Ranking Company Country Market capitalisation N 1 Berkshire Hathaway US $ 207 bn N 2 China Life China $ 95 bn N 3 Ping An China $ 65 bn N 4 Allianz Germany $ 64 bn Source: Financial Times 500, 2011 World players in the Chinese market Following China s entry to the WTO, the local insurance market largely opened itself to the establishment of foreign companies. However, even though practically all restrictions have been lifted, there still exists an obstacle to the creation of life insurance companies by foreign companies. In accordance with the Law of 12 December 2001, foreign companies can only invest in the life insurance market by creating a joint venture (JV) with a local partner and this JV may not be more than 50% owned by the foreign insurer. When the equity holding of the foreign insurer falls below 25%, the company is then considered a Chinese-owned company. The number of foreign companies has grown continuously over the first decade of the 21 st century. From 2001 to 2008, the number of foreign companies and JVs increased from 21 to 48, against an increase in Chinese companies from 14 to 82. Foreign companies are however still struggling against Chinese insurance giants in their quest for market shares. Thus, the top foreign insurer (AIA) is ranked 9 th in the general listing of companies offering life insurance in China with premiums collected equivalent to 2% of China Life s 5. In non-life insurance, the top foreign insurer (AIG) is ranked 27 th in the overall market. The total market share held by foreign insurers in the life insurance market is 3.7%, whilst their market shares are higher than 50% in Malaysia, Hong Kong, Singapore, the Philippines and Vietnam. In nonlife insurance, their total market share is 1.1%, compared to more than 50% in Singapore, Hong Kong and the Philippines. 5 CIRC Outlook for health and life insurance in China for use by foreign insurers Page 13

15 10,00% 8,00% 6,00% 4,00% 2,00% 0,00% Market shares held by foreign insurers 8,90% 8,00% 5,90% 4,90% 5,20% 5,60% 3,70% 2,60% 1,20% 1,30% 1,20% 1,20% 1,20% 1,10% 1,10% 1,10% Life Non- Life Source: PWC, Foreign Insurance Companies in China, December Moving towards a change in the place of foreign insurers. Although market shares held by foreign insurers seem to have stagnated, even regressed, it should be noted that they are operating in a landscape where local players are experiencing buoyant growth. Therefore, despite this, foreign insurers have improved their positions. The 28 foreign insurers who took part in a PwC study foresee a real change in the short-term. In 2011, companies assessed that between now and 2014: The number of approved life insurance companies will increase from 184 to 295 (up 60%) The number of approvals for non-life insurance companies will double (from 25 to 47) The payroll will increase by 39% for life insurance and 34% for non-life insurance The number of sales representatives will increase by 68% for life insurance and 29% for non-life insurance The number of individuals with life insurance will increase by 70% to 12 million The number of individuals with non-life insurance will increase by 76% to 880,000 Foreign companies therefore remain, on the whole, resolutely optimistic, but they are also waiting for the levers of opportunity to come into effect, as the possibility to trade mandatory car insurance products (currently reserved for local insurers and representing 70% of the non-life insurance market). Outlook for health and life insurance in China for use by foreign insurers Page 14

16 Quantitative outlook Contextual elements indicate that this growth is not about to run out of steam. Sustainable economic growth momentum Firstly, China has a very high rate of economic growth, despite the economic crisis by which it has also been affected. The Chinese economy has posted a growth rate of approximately 10% per year since 1978 which has resulted in a doubling of the standard of living every 8-9 years on average, taking into account demographic growth of 1% per year 6. This growth rate has helped China gain increasing significance in worldwide rankings. Country European Union United States Japan % Worldwide GDP China Source: World Bank This growth partly owes its success to extremely competitive exports. This trade surplus is valued at USD 15 billion and has allowed China to build a large foreign exchange reserve covering 18 months of imports and 10 times the short-term debt of the country. In addition to allowing China to maintain a favourable exchange rate for the Yuan, these reserves allow the Chinese economy to sustain its growth rate. This rate has shown to be very much above and beyond the worldwide averages in the short-, mediumand long-term. This growth would allow China to rise to the position of leading world power by While some experts foresee that this trend will lose momentum, it seems that the Chinese State has until now maintained this growth at a constant rate. In addition, as with every business, and all the more so with a service industry, the insurance sector is taking advantage of this opportunity and viewing the long-term as full of opportunities. Potential for major uptake Secondly, to date the rate of insurance penetration is still low but is set to increase. Analysis of the penetration typology helps determine that China is a market that is still far from maturity. Although life insurance represents 70% of this market, its penetration in GDP is still only 2.5%. 6 Wikipedia Outlook for health and life insurance in China for use by foreign insurers Page 15

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