短期健康险上半年赔付率观察：超六成险企不足50%，但有1412%“赔穿”，也有负值“倒赚”

Core Insights - The compensation ratio is a critical feedback mechanism for assessing the actuarial pricing ability and risk management level of insurance companies, serving as a key decision-making basis for strategy adjustments and model optimization [1] Group 1: Compensation Ratio Overview - As of August 1, 2025, 132 insurance companies have disclosed their short-term health insurance compensation ratios, with over 60% reporting ratios below 50%, while more than 10 companies have ratios exceeding 100% [2][3] - Short-term health insurance, typically covering periods of one year or less without guaranteed renewal clauses, is popular due to its high coverage and low cost [1][2] - The overall compensation ratio for short-term health insurance is relatively low, with a reasonable target around 70%, as excessively low ratios may indicate high product prices, while excessively high ratios could lead to insurer losses and unsustainable business [2][3] Group 2: Factors Influencing Compensation Ratios - Three main factors contribute to high compensation ratios in short-term health insurance: rising medical inflation, inadequate product pricing, and increased adverse selection risks [3] - The "wide entry, strict exit" nature of short-term health insurance attracts individuals with pre-existing conditions, leading to potential loss of control over claims due to weak underwriting processes [3] - A lack of health management services has resulted in most insurers remaining in a "post-claim" model, failing to reduce claim probabilities through disease prevention and chronic disease management [3] Group 3: Regulatory Environment and Market Dynamics - Regulatory bodies have issued guidelines to ensure insurance companies set reasonable rates and avoid excessively high coverage amounts that deviate from claims experience data [4][5] - The health insurance premium income for property insurance companies reached 160.9 billion yuan in the first half of 2023, marking a year-on-year growth of 9.08% [3] - The market for short-term health insurance is characterized by a concentration of leading companies holding over 60% market share, while smaller companies seek survival through niche segments [6] Group 4: Future Trends - The future of short-term health insurance is expected to evolve in three dimensions: upgrading product forms to integrate services and coverage, breakthroughs in risk control technology through real-time health data monitoring, and deepening ecological collaboration between insurers and healthcare providers [6] - Regulatory guidance will continue to promote long-term reforms, allowing for extended guaranteed renewal periods up to 20 years, shifting the industry focus from short-term strategies to long-term operations [6]