惠民保如何应对“逆向选择”难题

Core Viewpoint - The emergence of urban commercial health insurance, represented by "Beijing Puhui Health Insurance" and "Shuhui Bao," has significantly increased participation but faces sustainability challenges as a supplementary basic medical insurance product [1][2]. Group 1: Current Status and Challenges - "Beijing Puhui Health Insurance" has seen a substantial increase in participants compared to last year, indicating a growing acceptance of such products [1]. - The product addresses gaps in basic medical insurance, particularly for high-cost imported drugs and advanced medical technologies, which are significant risks for families facing severe illnesses [1]. - However, the sustainability of these products is under scrutiny due to structural issues in the participant demographics, leading to adverse selection where unhealthy individuals are more likely to enroll, increasing the payout ratio [2]. Group 2: Policy and Governance - The "14th Five-Year Plan" emphasizes the need for a multi-tiered social security system, highlighting the importance of commercial insurance as a supplementary measure [3]. - Transitioning from a phenomenon to a stable institutional arrangement for "惠民保" is crucial for enhancing the social security system, requiring collaboration between local governments and the insurance industry [3]. Group 3: Role of Local Governments - Local governments should evolve from being mere promoters to planners and stabilizers, focusing on top-level design and actuarial guidance to avoid blind competition and ensure a balance between affordability and sustainability [4]. - Establishing regional risk adjustment funds or reinsurance mechanisms could provide backup support for projects facing high payout rates, similar to social security fund operations [4]. Group 4: Insurance Industry Transformation - The insurance industry needs to shift from aggressive market expansion to meticulous management, emphasizing proactive health management and enhancing the claims experience for participants [5]. - By integrating technology and offering value-added services, insurance companies can reduce the risk of disease occurrence and improve customer satisfaction through transparent and efficient claims processes [5]. - The future of "惠民保" hinges on collective efforts to ensure it becomes a vital component of China's multi-tiered medical security system [5].