商业健康险深度报告：如何判断国内商业健康险的空间？

Industry Investment Rating - The report maintains a "Stronger than Market" rating for the healthcare and life sciences industry [1] Core Views - The report aims to address three key questions regarding the development space of domestic commercial health insurance in China [2] - Despite the premium income of domestic commercial health insurance accounting for 10.2% of healthcare expenses in 2023, the actual payment increment from commercial insurance is not felt in medical institutions [3] - The report explores the theoretical space for future development of commercial health insurance and compares it with international benchmarks, suggesting that China's penetration rate could surpass that of Germany and France [3] - The report discusses the potential impact of recent policy statements from the National Healthcare Security Administration on data empowerment and future policy directions [3] Commercial Health Insurance Overview - The premium income and expenditure of commercial health insurance have slowed since 2020, with expenditure accounting for a relatively low proportion of total healthcare expenses [8] - From 2009 to 2023, the premium income of domestic commercial health insurance grew from 57.4 billion yuan to 903.5 billion yuan, with a CAGR of 21.8%, while expenditure grew from 21.7 billion yuan to 383.1 billion yuan, with a CAGR of 22.8% [8] - In 2023, the premium income of commercial health insurance accounted for 10% of total healthcare expenses, while expenditure accounted for only 4.2% [8] Income Structure - Disease insurance remains the largest contributor to commercial health insurance premium income, accounting for 51% in 2023, with critical illness insurance making up 46% [16] - Medical insurance has seen an increase in its share, accounting for 42% in 2023, with group medical insurance contributing 21% and million-yuan medical insurance contributing 7% [16] Expenditure Structure - Medical insurance accounts for the highest proportion of expenditure, with group medical insurance contributing 40% in 2023 [30] - The average claim ratio of domestic commercial health insurance is significantly lower than that of developed countries, with a claim ratio of only 48% in 2021, compared to 70-85% in developed countries [33] - The claim ratio for disease insurance is particularly low at 21%, while medical insurance has a higher claim ratio of 75%, but the main insurance types covering out-of-pocket expenses, such as million-yuan medical insurance, have a claim ratio of only 20-30% [3] International Comparisons - The penetration rate of commercial health insurance in China could surpass that of Germany and France, with a neutral forecast suggesting a potential 3.1X increase in medical insurance income and a 1.9X increase in commercial health insurance income [3] - In the US, commercial insurance is the core payer, accounting for 29% of healthcare expenditure in 2022, covering 65.2% of the population [39] - In Germany, statutory health insurance (SHI) accounts for 53% of healthcare expenditure, with private health insurance playing a supplementary role [64] - In France, social basic health insurance (SHI) accounts for 74% of healthcare expenditure, with commercial health insurance covering 96.7% of the population [92] Policy Impact and Future Directions - The lack of data resources is a core bottleneck for the development of commercial health insurance, and the empowerment of healthcare data can help in product design, underwriting, and claims processing [3] - Future policies to watch include changes in DRG cost control methods, further refinement of data sharing by the healthcare security administration, regulatory acceptance of innovative products, and increased tax subsidies and administrative support from the government [3] Investment Recommendations - The report recommends focusing on sectors that benefit from incremental payment funds, such as innovative drugs and the innovative drug industry chain [3] - It also suggests paying attention to serious medical services that are undervalued due to healthcare cost control, such as International Medical, Hygeia Healthcare, and New Journey [3] - Companies benefiting from healthcare data processing and development, such as Guoxin Health, Jiuyuan Yinhai, and Wanda Information, are also recommended [3]