平均赔付率45% 你买的短期健康险真的赔到了吗？

Core Viewpoint - The current state of short-term health insurance in China shows a low comprehensive claims ratio, indicating insufficient consumer protection and trust in insurance companies [2][3][8]. Claims Ratio Analysis - The median comprehensive claims ratio for short-term health insurance from 2023 to mid-2025 has increased from 38.83% to 42.12% for life insurance companies, and from 38.70% to 42.30% for property insurance companies [4]. - A total of 120 insurance companies reported a median claims ratio of 42.12%, with an average of 45% after excluding outliers [2][4]. - Only 19.1% of the companies reported a claims ratio between 60% and 100%, indicating that achieving a higher claims ratio is challenging [4]. Company Performance - Companies like China Life, Ping An Health, and Taikang Life have reported claims ratios above 50%, while others like ZhongAn Insurance and Taikang Online have much lower ratios, indicating a disparity in performance among insurers [8][9]. - Some companies reported negative claims ratios due to low business volume, while others exceeded 100% claims ratios, highlighting the variability in the market [5][8]. Market Dynamics - The low claims ratios are attributed to high operational costs, including online marketing and distribution expenses, which compress the space for actual claims payouts [9][10]. - The insurance market is seeing a shift towards digital marketing and the need for companies to adapt to changing consumer behaviors and expectations [9][14]. Future Outlook - There is a consensus among industry experts that the ideal claims ratio for short-term health insurance should be between 50% and 70% to ensure consumer satisfaction and company sustainability [3][12]. - The increasing pressure on basic medical insurance funds highlights the growing importance of commercial health insurance, especially with the implementation of new payment methods [10][11]. - Innovations in insurance products and expanding coverage to include more health-related services are seen as necessary steps for improving claims ratios and consumer trust [13][14].