“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 fully established system by the end of 2025, aiming to cover nearly 300 million people and provide support for over 3.3 million disabled individuals, with total fund expenditures exceeding 100 billion yuan [1]. Group 1: Challenges and Risks - The LTCI system has faced fragmentation issues, leading to uneven regional burdens and undermining fairness, with significant reliance on a single funding source, primarily the medical insurance fund [3][5]. - The projected number of disabled individuals in China is expected to rise from 34 million in 2025 to 62 million by 2050, creating a substantial funding demand that current medical insurance reserves cannot sustain [5]. - The lack of standardized disability assessment criteria has resulted in disparities in benefits across regions, necessitating a unified approach to ensure equitable access to services [5][6]. Group 2: Policy and Standardization - The National Medical Insurance Administration has announced plans to standardize funding, benefits, and payment policies to establish a solid foundation for the sustainable development of the LTCI system [5][6]. - A new research project on optimizing disability assessment standards is set to enhance the consistency and traceability of evaluations across the country [6]. Group 3: Role of Insurance Companies - Commercial insurance companies are acting as third-party administrators for LTCI, managing funds and overseeing service quality, but are currently operating in a low-profit environment [8][9]. - The shift towards a fully established LTCI system will require insurance companies to enhance their professional capabilities and adapt to stricter regulatory standards [9][10]. Group 4: Opportunities for Commercial Insurance - The LTCI system's establishment is expected to drive demand for commercial insurance products, particularly in areas not covered by the national program, such as moderate disability and specialized care for high-net-worth individuals [12][13]. - Insurance companies are encouraged to innovate their service offerings, including higher benefit levels and personalized care options, to meet diverse consumer needs [13]. Group 5: Future Outlook - The LTCI system's expansion presents an opportunity for insurance companies to transition from mere payers to integral players in the elder care ecosystem, focusing on service integration and resource optimization [13].