从跑马圈地到存量优化，惠民保新趋势：重点突破特药保障目录

Core Insights - The article discusses the rapid development and evolution of urban customized commercial health insurance (Hui Min Bao) in China since its launch in 2020, highlighting its significance in the multi-tiered medical security system [1][3]. Group 1: Market Development - As of July 2023, a total of 313 local Hui Min Bao products have been launched nationwide, with a market growth rate of 2.96% [4]. - The market is transitioning from "incremental expansion" to "stock optimization," indicating a shift towards high-quality development [4]. - The proportion of normally operating products is expected to decrease from 74.3% in 2023 to 66.78% in 2024, reflecting a decline of approximately 7.5 percentage points [4]. Group 2: Product Diversification - The need for product stratification is emphasized to meet the diverse needs of different income groups and health conditions, suggesting a model of "basic version + upgraded version + inclusive critical illness insurance" [5]. - New products have been introduced to enhance coverage, such as a new inclusive critical illness insurance product in Guangdong and three "Guardian Insurance" products in Guangxi [4]. Group 3: Special Drug Coverage - Special drug coverage has become a key innovation area for Hui Min Bao, with an average of 41 special drugs covered per product, focusing on 28 types of indications [6]. - Over 80% of traditional Hui Min Bao products include special drug responsibilities, primarily targeting malignant tumors and expanding to rare diseases and other treatment areas [6]. - The inclusion of CAR-T therapy and local innovative drugs aims to alleviate the financial burden on patients and support the development of the domestic biopharmaceutical industry [6]. Group 4: Sustainability Concerns - The low premium model raises concerns about the sustainability of expanding special drug coverage, with risks of adverse selection and medical cost inflation [7]. - Future sustainability relies on refined management strategies, including setting reasonable deductibles, controlling drug costs, and increasing enrollment rates to diversify risk [7].