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重磅!推动健康保险高质量发展指导意见出台,打通卡点堵点,明确未来发展方向
13个精算师· 2025-09-30 12:11
Core Viewpoint - The article discusses the issuance of the "Guiding Opinions on Promoting High-Quality Development of Health Insurance" by the Financial Regulatory Bureau, emphasizing the need to enhance the health insurance sector's service and guarantee levels in response to increasing health protection demands and the aging population [1][12]. Summary by Sections 1. Increasing Demand for Health Insurance - The demand for health insurance is rising due to an aging population and increasing life expectancy, with the average life expectancy in China reaching 79 years [5]. - There is a growing need for commercial health insurance products, particularly for quick settlement of medical expenses and coverage of more medications not included in basic medical insurance [7][8]. 2. Breaking Through Bottlenecks - The health insurance sector has seen rapid growth since 2014, with commercial health insurance premium income expected to reach 977.3 billion by the end of 2024, more than six times the amount a decade ago, with a compound annual growth rate of approximately 20% [11]. - Despite this growth, challenges such as product homogeneity and insufficient operational capabilities are emerging, which hinder service improvement [11][12]. 3. Deepening Health Insurance Reform - The opinions outline a focus on enhancing the health management service system and promoting collaboration between health insurance and the healthcare industry [15][22]. - Specific areas of development include commercial medical insurance, long-term care insurance, and disability income loss insurance, with a push for integrating new medical technologies and drugs into insurance coverage [16][20]. 4. Enhancing Sustainable Development Capabilities - The article emphasizes the need for insurance companies to strengthen their responsibilities and improve actuarial management, as well as to enhance the professional talent pool in health insurance [24][25]. - It also highlights the importance of digital transformation and the use of big data and AI to improve operational efficiency and customer satisfaction [25]. 5. Strengthening Health Insurance Regulation - The regulatory framework will be improved to ensure compliance and fair pricing in health insurance products, with a focus on enhancing the overall market order [27][28]. - Measures will be taken to combat malpractice and protect consumer rights, ensuring a more transparent and efficient health insurance market [28]. 6. Optimizing the Health Insurance Development Environment - The article calls for the establishment of standardized health insurance clauses and evaluation systems to improve service quality and consumer understanding [31][32]. - It also encourages collaboration between various stakeholders to promote the development of group health insurance and improve public awareness of health insurance [32]. 7. Future Arrangements - The Financial Regulatory Bureau plans to create a favorable policy environment for health insurance development and to enhance product offerings to meet public demand for high-quality health protection [35].