“社保第六险”已覆盖近3亿人，转向全面建制

Core Viewpoint - The Long-term Care Insurance (LTCI) system in China is transitioning from pilot programs to a comprehensive national framework, aiming to address the challenges of an aging population and provide essential care services for disabled individuals [2][4][6]. Group 1: LTCI System Development - The LTCI system, referred to as the "sixth social insurance," is expected to cover nearly 300 million people and benefit over 3.3 million disabled individuals by the end of 2025, with total expenditures exceeding 100 billion yuan [2]. - The pilot phase of LTCI, which began in 2016, has revealed issues such as fragmentation and varying standards across regions, necessitating a unified approach for sustainable development [4][5]. - The National Healthcare Security Administration (NHSA) plans to standardize funding, benefits, and payment policies to ensure high-quality and sustainable development of the LTCI system [6][7]. Group 2: Financial Sustainability and Challenges - The projected number of disabled individuals in China is expected to reach 34 million by 2025 and 62 million by 2050, leading to a significant increase in funding requirements for long-term care [5]. - Current funding mechanisms primarily rely on medical insurance funds and local government subsidies, which pose sustainability risks due to demographic changes [4][5]. - A multi-channel funding approach is essential to address the financial challenges associated with the nationwide implementation of LTCI [5]. Group 3: Role of Insurance Companies - Insurance companies are acting as third-party administrators for LTCI, managing funds and overseeing service quality rather than providing direct care [9]. - The current business model for insurance companies in LTCI is characterized by low profitability, with a shift towards value creation and innovation expected as the system matures [10][11]. - Companies are exploring technology-driven solutions to enhance operational efficiency and reduce costs, indicating a transition from traditional service models to integrated care solutions [10][11]. Group 4: Market Opportunities for Commercial Insurance - The LTCI system's comprehensive establishment is anticipated to create new growth opportunities for commercial insurance by addressing gaps in coverage for moderate disabilities and specialized care needs [15][16]. - Commercial insurance can develop tailored products for underrepresented groups, such as those with moderate disabilities and dementia, enhancing the overall care landscape [15][16]. - The integration of commercial insurance with high-end care services and personalized offerings is expected to meet diverse consumer demands and expand market reach [16][17].