经济观察报·2025-09-24 02:30Core Viewpoint - The comprehensive claim ratio of short-term health insurance in the industry is low, with a median of 42.12% and an average of 45%, indicating insufficient consumer protection and trust in insurance companies [1][3][4]. Summary by Sections Comprehensive Claim Ratio - The comprehensive claim ratio is a crucial indicator of insurance product protection, with a higher value indicating more payouts to consumers [4]. - The current ratio of around 45% is considered low, with industry professionals suggesting a more reasonable range of 50%-70% for better consumer experience and sustainable operations [4][11]. Trends Over Time - From 2023 to the first half of 2025, the median claim ratio for life insurance companies increased from 38.83% to 42.12%, while for property insurance companies, it rose from 38.70% to 42.30% [6]. - Among the insurers reporting data, 11 had negative claim ratios, and 9 exceeded 100%, with 44 companies falling between 0%-40% and 33 between 40%-60% [6]. Company Performance - Major insurers like China Life, Ping An Health, and others have claim ratios above 50%, while companies like Zhong An Insurance and Tai Kang Online have significantly lower ratios [11]. - The disparity in claim ratios among companies is influenced by their product focus, with those offering broader coverage typically having higher ratios [14]. Cost Structure and Profitability - Low claim ratios do not necessarily equate to high profits for insurance companies, as high operational costs can offset potential gains [13]. - The competitive landscape for acquiring customers, especially through digital channels, has led to increased costs, impacting claim ratios [13]. Market Dynamics - The importance of commercial health insurance is growing, especially with reforms in payment methods that open new opportunities for development [16]. - The current short-term health insurance products primarily cover out-of-pocket expenses after basic insurance reimbursements, often with high deductibles [16]. Future Outlook - There is a recognized need to improve the claim ratio by at least 20 percentage points to enhance consumer satisfaction and trust [16]. - Strategies to increase consumer engagement and expand coverage are being explored, including targeting sub-healthy and sick populations [18][19]. - Government initiatives to support group health insurance purchases may provide a significant boost to the commercial health insurance market [20].