破局医保“不可能三角”，商业健康险需从“边缘补充者”到“生态协同者”

Core Insights - The report highlights the critical role of commercial health insurance in China's healthcare system transformation due to the accelerating aging population [1][2] - By 2024, the population aged 65 and above in China will account for 15.6%, entering a deep aging society, with projections indicating this will rise to 42% by 2070 [1] - The report emphasizes the need for a multi-tiered healthcare security system to address the "impossible triangle" of low cost, high accessibility, and high quality in healthcare services [2] Summary by Sections Aging Population and Healthcare Challenges - The aging population is leading to increased healthcare demands and challenges for the sustainability of basic medical insurance funds [1] - In Shanghai, the total reimbursement amount for three major diseases among the elderly is projected to reach 81.1 billion yuan by 2070 under a 3% annual medical inflation scenario [1] Multi-Tiered Healthcare Security System - The report proposes a "1+3+N" framework for a multi-layered healthcare security system, which includes a unified national medical insurance information platform, basic medical insurance, medical assistance, and major illness insurance [2] - The report stresses the importance of a diversified and multi-tiered security system to effectively address the challenges in the healthcare sector [2] Transition of Commercial Health Insurance - The transition of commercial health insurance from a "marginal supplement" to an "ecological collaborator" is essential for enhancing the healthcare system [2][3] - Key focus areas for this transition include covering costs not included in basic medical insurance, addressing specific demographic needs, and providing high-quality medical services [3] Addressing Core Issues in Commercial Health Insurance - The report identifies a core contradiction in commercial health insurance: the imbalance between profit models and social trust, which affects participation rates [3] - Recommendations include lowering entry barriers, expanding coverage, and leveraging data to enhance customer experience and trust [4] Future Development Strategies - The development of commercial health insurance should prioritize customer-centric approaches, long-term strategies, and risk-sharing mechanisms to create a sustainable model [4] - The core competitiveness of commercial health insurance will rely on its ability to provide supplementary value and achieve sustainable development through trust, scale effects, and policy collaboration [4]