健康险保费规模近万亿，带病人群为何“可保难赔”丨“病有所保”大调研

Core Insights - The health insurance market in China is experiencing a transformation, with a focus on expanding coverage to individuals with pre-existing conditions, as nearly 400 million people fall into this category and contribute about 60% of medical expenses but only 5% of commercial insurance premiums [1][2][3] - Regulatory bodies are pushing for innovation in health insurance products to better serve the needs of the sick population, moving from a model that primarily covers healthy individuals to one that supports the health of all individuals [2][6] - The market for insurance products catering to individuals with pre-existing conditions is still underdeveloped, despite the potential for growth and the increasing demand for tailored insurance solutions [3][4][5] Market Dynamics - The health insurance premium scale in China is approaching 1 trillion yuan, indicating a reversal in the previous trend of slowing growth [1] - The introduction of products that relax pre-existing condition restrictions, such as million medical insurance, is becoming more common, yet challenges remain in underwriting and claims processes for individuals with health issues [1][5] - The insurance industry has seen a shift towards group insurance and community-based insurance products, which currently dominate the market for individuals with pre-existing conditions [4][5] Regulatory Environment - Recent policy initiatives encourage insurance companies to develop products that include coverage for older adults and those with chronic illnesses, aiming to create a more inclusive insurance landscape [2][3] - The regulatory framework is evolving to support the development of innovative insurance products that can meet the needs of a broader range of health conditions [6][7] Product Innovation - The insurance industry is gradually moving towards offering long-term medical insurance products, which provide better coverage and continuity for individuals as their health status changes over time [5][6] - There is a growing recognition of the need for insurance products that address the specific needs of individuals with chronic conditions, although many still face barriers to obtaining coverage [5][9] Challenges and Opportunities - The insurance sector faces challenges in accurately pricing and managing the risks associated with insuring individuals with pre-existing conditions, which can lead to high premiums that deter potential customers [9] - The market for innovative drugs and therapies is expanding, but insurance coverage for these treatments remains limited, highlighting a gap between patient needs and insurance offerings [7][8] - The potential for growth in the health insurance market is significant, but requires a shift in how insurance products are designed and marketed to effectively reach and serve individuals with health issues [9]