陈剖建：银发浪潮下的时代课题——老龄化社会与商业健康险的机遇与挑战

Core Viewpoint - The 20th China Insurance Innovation Forum highlighted the strategic opportunities and challenges faced by commercial health insurance in the context of China's accelerating aging process, emphasizing the need for regulatory support and differentiated management for specialized health insurance companies [1][17][18]. Group 1: Aging Population and Coverage Gaps - China has entered a deep aging society, with the population aged 65 and above reaching 15.6% by 2024, and projections indicate that this will exceed 30% by 2050 [4][21]. - The aging population has led to a significant increase in healthcare costs, with individuals aged 65 and above incurring medical expenses 6.1 times higher than those aged 15-44 [5][22]. - The basic medical insurance system is under pressure, with total income of approximately 3.4 trillion yuan and expenditures exceeding 2.9 trillion yuan in 2024, resulting in a limited surplus of only 400 billion yuan [6][22]. Group 2: Market Opportunities - The multi-level insurance design and policy support create a favorable environment for the growth of commercial health insurance, transitioning from optional to necessary components of healthcare [8][24]. - There is a significant unmet demand for health insurance, with 45% of healthcare costs not covered by basic medical insurance, creating a market gap worth trillions [8][24]. - The expanding middle class, with around 400 million individuals, is increasingly willing to invest in personalized healthcare services, providing a solid foundation for filling the coverage gap [9][25]. Group 3: Challenges in Product, Pricing, and Service - There is a notable gap in long-term care insurance products, with less than 5% of commercial insurance specifically designed for elderly care, despite over 44 million elderly individuals needing such services [11][26]. - The mismatch between product offerings and consumer preferences is evident, as over 65% of individuals aged 50 and above prefer insurance products that combine savings and protection, yet 90% of available health insurance products are purely consumption-based [12][27]. - Pricing challenges arise from the need to balance affordability for consumers and sustainability for insurance companies, necessitating a shift towards more precise and phased pricing models [14][29]. Group 4: Professionalization of Health Insurance - The establishment of a specialized health insurance system is essential to address the unique risks and service needs associated with aging, requiring regulatory support and differentiated management [16][31]. - Current challenges include a lack of specialized policies and the need for professional institutions to support the unique nature of health insurance, which differs fundamentally from life insurance [16][31]. - The industry must advocate for regulatory frameworks that allow for innovation and flexibility in product approval and pilot programs to foster long-term development [18][31].