惠民保十年启示：让市场的部分归市场

Core Insights - The article discusses the challenges faced by Huiminbao, a type of supplementary health insurance in China, which cannot freely price or manage risks like commercial insurance, nor can it enforce participation and provide fiscal backing like social insurance [1][2]. Group 1: Market Trends - Huiminbao, introduced in Shenzhen in 2015 and expanded nationwide in 2020, is currently in a market adjustment phase, with the proportion of operational products decreasing from 74.3% in 2023-2024 to 66.78%, and further to 65.54% in 2024-2025 [2]. - As of July 2023, there are 313 Huiminbao products with over 171 million participants, highlighting its role in alleviating high out-of-pocket medical expenses [2][3]. Group 2: Challenges and Risks - The average participation rate for 53 publicly available Huiminbao products in 2023 was only 18.9%, significantly below the critical threshold of 70%-80% needed for effective risk dispersion [3]. - Many Huiminbao projects are facing a "death spiral" due to low participation rates and high claim thresholds, with some regions requiring a payout rate of 80%, leading to increased financial strain on these programs [3][4]. Group 3: Strategies for Improvement - To enhance participation rates, some regions have expanded eligibility to flexible employment groups and allowed the use of personal medical account balances for payments, although these measures may face diminishing returns [4]. - Insurance companies are encouraged to transition towards health management service providers, utilizing data analytics for better risk management and offering value-added services to increase user engagement [5]. Group 4: Future Directions - The article suggests that the government should focus on long-term institutional support rather than short-term interventions, allowing the market to operate more freely while enhancing the role of commercial insurers in Huiminbao projects [4][5]. - There is a call for greater clarity in coverage responsibilities, improved pricing models based on demographic factors, and a reduction in product homogeneity to restore consumer confidence and industry reputation [4][5].