万亿元门槛前的健康险：“一冷一热”背后 价值坐标重塑

Core Insights - The health insurance sector fell short of the long-anticipated "trillion yuan premium" milestone in 2025, achieving a total premium income of 997.3 billion yuan, just shy of the target [1] - The growth rate of health insurance premiums has slowed significantly, with a mere 2% increase in 2025 compared to 8% in 2024, indicating a shift in the growth dynamics of the insurance industry [1][2] - The decline in the sales of critical illness insurance, which has historically been a major driver of growth, has led to a stagnation in the overall health insurance market [2][3] Premium Growth and Market Dynamics - In 2023, health insurance premiums surpassed 900 billion yuan, reaching 903.5 billion yuan, and increased to 977.4 billion yuan in 2024, but the growth has significantly decelerated in 2025 [1] - The primary reason for the slowdown is attributed to the declining sales of critical illness insurance, which has seen stagnant or even shrinking premium scales, adversely affecting the overall market growth [2] - Rising premiums and decreasing coverage for the same premium amount have led consumers to forgo purchasing critical illness insurance [2] Shift to Medical Insurance - As critical illness insurance growth stagnates, medical insurance is expected to take the lead in the health insurance sector, with anticipated high growth rates driven by innovations in payment methods and product offerings [3][4] - The current trend in medical insurance is evolving from standard hospitalization coverage to more comprehensive plans that include outpatient services, special needs, and health management [3] - The commercial health insurance sector is projected to see a total payout of 14.7 billion yuan for innovative drugs and devices by 2025, reflecting a compound annual growth rate of 70% [3] Future Growth Engines - The aging population and the associated risks of "longevity but disability" are expected to drive the growth of nursing insurance, which is shifting from savings-type to protection-type products [4] - Industry experts emphasize the need for continuous innovation to address specific consumer needs, with medical and nursing insurance becoming key growth drivers [4][5] - The competitive landscape is shifting towards not just pricing and policy terms but also the integration of medical resources and health service ecosystems [4][5] Strategic Directions - The health insurance sector is moving towards a model where a competitive policy is not just a contract but a comprehensive health solution that includes various services and benefits [4][5] - The upcoming regulatory frameworks, such as the "Guiding Opinions on Promoting High-Quality Development of Health Insurance," are expected to provide new directions for specialized development in the industry [5] - Companies are encouraged to develop differentiated products tailored to various demographics and scenarios, enhancing collaboration with medical institutions to create a holistic health management service [5][6]