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健康险破局路线图:与三医融合,做三大跃迁 | 保险家论道
清华金融评论· 2025-09-04 11:14
Core Viewpoint - The article emphasizes the necessity for insurance companies to transition from a reliance on interest rate spreads to a balanced approach, particularly focusing on enhancing mortality gains through the development of commercial health insurance as a key strategy for navigating the current economic landscape [4][5]. Summary by Sections 1. Market Trends and Opportunities - The aging population and ongoing healthcare reforms present a significant opportunity for the growth of commercial health insurance, aligning with national strategic directives to expand health insurance coverage and improve medical service efficiency [5][6]. - By 2024, the number of individuals covered by basic medical insurance in China is expected to exceed 1.3 billion, maintaining a coverage rate of over 95%, while commercial health insurance is projected to generate nearly 1 trillion yuan in premium income [7][8]. 2. Integration with Healthcare Systems - The future of commercial health insurance is closely tied to the integration of medical services, medical insurance, and pharmaceuticals (the "three medicals"), which is essential for its development [6][7]. - The article outlines three major transitions necessary for this integration: cognitive transition, institutional transition, and technological transition [7][8]. 3. Cognitive Transition - The changing landscape of healthcare demands a comprehensive understanding of evolving medical insurance needs, driven by factors such as an aging population and rapid advancements in medical technology [8][9]. - The article highlights the need for commercial health insurance to adapt to diverse healthcare demands across different income groups, necessitating the development of varied insurance products [10][11]. 4. Institutional Transition - A robust legal framework for healthcare insurance is crucial for the integration of health insurance and the three medicals, with recent legislative efforts aimed at enhancing the sustainability and fairness of the healthcare system [15][16]. - The establishment of a multi-pillar, multi-tiered healthcare system is essential, incorporating basic medical insurance, employer-sponsored insurance, and individual commercial health insurance to create a comprehensive safety net [17][18]. 5. Technological Transition - The integration of data standards and the use of AI are pivotal for enhancing the efficiency and effectiveness of health insurance and healthcare services [21][22]. - AI can play a significant role in controlling healthcare costs and preventing fraud, thereby improving the overall integrity of the insurance system [23][24]. 6. Support for Biopharmaceutical Development - The convergence of medical insurance and commercial health insurance can provide comprehensive support for the biopharmaceutical industry, facilitating funding for research and development and ensuring the market accessibility of innovative treatments [25].