中国商业健康险保费收入接近万亿，还面临哪些挑战

Core Viewpoint - The development of commercial health insurance in China is accelerating, driven by policy support, but faces challenges in improving payout levels and effectively supporting innovative medical products [1][2][4] Group 1: Market Overview - Nearly 180 insurance companies in China are qualified to operate commercial health insurance, offering over 5,000 products [1] - The health insurance premium income for 2024 is projected to reach 977.4 billion yuan, indicating significant growth potential despite being below the target of over 2 trillion yuan by 2025 [1] - Commercial health insurance currently accounts for approximately 20% of the medical security market, nearing 1 trillion yuan [2] Group 2: Payout and Coverage - The total payout of commercial health insurance in 2023 was about 380 billion yuan, representing around 7% of residents' medical expenses [2] - The payout ratio for short-term health insurance is generally considered to be in the range of 50% to 80%, with many products currently falling short of this benchmark [3] - The median payout ratio for short-term health insurance in 2024 is reported at 40.3% for life insurance companies and 36.5% for property insurance companies [3] Group 3: Product Innovation and Challenges - There is a need for product innovation to include more elderly and chronic disease patients in commercial health insurance coverage [5] - Specialized insurance products for specific diseases and pre-existing conditions are emerging as growth points, but face challenges in risk assessment and sales channels [5][6] - The integration of innovative medical products into insurance coverage is becoming increasingly important, with a focus on developing insurance products that provide future medication coverage for patients [6] Group 4: Policy and Regulatory Environment - The implementation of the "B-class drug" directory is anticipated to enhance the payout scale for innovative drugs under commercial health insurance [7] - There is a call for improved coordination among pharmaceutical companies, medical institutions, and insurance companies to create a comprehensive support system for innovative medical products [7] - The development of group insurance is seen as a key strategy to increase participation rates in commercial health insurance, with suggestions for policy support and product innovation [8]