普惠保险破局：从“牙签”到支柱的生态重构

Core Insights - The current structure of China's healthcare insurance system shows a significant imbalance, with basic medical insurance accounting for 50% of total medical expenses, while commercial health insurance only covers about 7% of the total [1][6] Group 1: Current State of Insurance - In 2023, China's medical insurance expenditure reached 2.8 trillion yuan, while personal health expenditure was 2.5 trillion yuan, indicating a reliance on basic insurance [1] - The coverage of commercial health insurance is limited, with payouts around 0.38 trillion yuan, highlighting the need for better risk protection for vulnerable groups such as flexible workers and the elderly [1][4] - The penetration of inclusive insurance remains low, with only 7% of overall insurance premium income attributed to inclusive insurance products [6] Group 2: Challenges in Inclusive Insurance - The industry faces a fundamental challenge known as the "impossible triangle," which involves balancing low premiums, high coverage, and commercial sustainability [6][9] - There is a structural mismatch in the supply of inclusive insurance products, with a concentration on short-term health insurance and insufficient offerings for high-risk groups like the elderly and chronic disease patients [7][8] - Some inclusive insurance products, such as "Hui Min Bao," are at risk of being discontinued due to high payout rates and declining participation [7] Group 3: Future Directions - The development of inclusive insurance must transition from a single product focus to a more systemic and ecological approach, leveraging policy guidance, market forces, and technological empowerment [9][10] - Experts emphasize the importance of collaboration between government and commercial entities to ensure the sustainable development of inclusive insurance [10] - Future inclusive insurance models are expected to evolve beyond traditional compensation to include comprehensive solutions that integrate insurance, services, and technology [11]