万亿规模健康险，带病人群为何“可保难赔”

Core Insights - The health insurance market in China is approaching a premium scale of nearly 1 trillion yuan in 2024, reversing a trend of slowing growth seen in the previous three years, yet the market for individuals with pre-existing conditions remains largely excluded [2][3] - The industry is under pressure to transform from insuring healthy individuals to focusing on the health of all individuals, particularly those with pre-existing conditions, as regulatory bodies encourage innovation in product offerings [3][4] - Approximately 400 million people in China belong to the "sick population," contributing about 60% of medical expenses but only accounting for around 5% of commercial insurance premiums [2][4] Market Dynamics - The health insurance sector is experiencing a shift towards accommodating individuals with pre-existing conditions, with recent regulatory encouragement for insurance companies to develop products that include these groups [4][5] - The lack of long-term, high-quality data in China's health insurance market has hindered the ability of insurance companies to accurately assess and price risks associated with different health statuses [5][6] - The market for insurance products catering to individuals with pre-existing conditions has seen limited growth, with the total premium for such insurance remaining around 50 billion yuan, primarily sourced from group insurance and community-based health plans [6][7] Product Innovation - Recent developments in insurance products have seen a transition from short-term to long-term medical insurance plans, which promise continuity of coverage and better risk management for individuals transitioning from healthy to sick [7][9] - The introduction of specialized insurance products targeting specific health conditions, such as chronic diseases and cancer, is gradually expanding the market, although significant gaps in coverage for high-risk individuals remain [8][9] - The insurance industry is exploring new ways to innovate in product design, including leveraging medical data to enhance pricing accuracy and risk assessment capabilities [9][10] Challenges and Opportunities - The integration of innovative drugs and therapies into health insurance coverage remains a challenge, with insurance companies often lacking precise evaluations of the costs and usage rates of these treatments [10][11] - The disparity between the needs of patients requiring innovative treatments and the insurance products available highlights a significant gap in the market that needs to be addressed [11][12] - The willingness of the sick population to pay higher premiums for insurance coverage is crucial for the sustainability of these products, as high-risk individuals typically face higher costs [12]