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商业健康险破局与未来
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管培:商业健康险的破局与未来
清华金融评论· 2025-06-13 11:01
Core Viewpoint - The insurance industry must adapt to the evolving landscape shaped by healthcare reforms, focusing on commercial health insurance as a complementary role to basic medical insurance, while enhancing service integration and social responsibility [5][6]. Group 1: Market Dynamics - The current healthcare reform is reshaping China's multi-tiered medical security system, with commercial health insurance expected to play a supplementary role to the basic medical insurance system, which covers 1.35 billion people, achieving a coverage rate of 95% [5]. - The recent reforms in medical payment and catalog have created opportunities for commercial insurance to fill gaps left by basic insurance, indicating a shift towards a multi-layered structure where commercial insurance becomes a co-builder of the system [5]. Group 2: Product Development - Life insurance companies possess a natural advantage in long-term and holistic solutions, but face challenges in designing products for high-risk groups, such as those with pre-existing conditions, due to the complexity of risk assessment and market acceptance [6]. - The industry needs to develop more inclusive risk identification models and underwriting standards, as well as promote data sharing and policy collaboration to ensure the sustainability of commercial health insurance [6]. Group 3: Service Innovation - There is a growing demand for health insurance services tailored for expatriates, particularly those from state-owned enterprises stationed overseas, which includes not only basic medical coverage but also emergency transport and family visit services [7]. - The establishment of effective service mechanisms for expatriates faces challenges such as complex risk assessments and high dependency on qualified rescue service providers, which can increase costs [7]. - The industry aims to enhance overall underwriting capacity and service levels through collaborative platforms that facilitate data sharing and capability integration [8].