2025.09. 02 本文字数：3950，阅读时长大约6.5分钟 作者 | 第一财经 吴斯旻 "得了癌症，还可以买商保吗？" 近年来，我国医保体系在保障覆盖范围方面取得显著进展，多种昂贵肿瘤靶向药被纳入医保乙类目 录。但"覆盖不等于可及"，一份由中疾控慢病中心、昆山杜克大学等机构研究人员共同发布的最新研 究揭示，在我国部分癌症治疗中，患者的自付比例已经接近或超过50%。伴随"带癌生存"群体逐渐增 多，患者们逐渐将目光投向商保。 尽管在谈及商业健康保险（下称"健康险"）对创新药的赔付时，大量的行业数据显示肿瘤治疗药物长 年占据"半壁江山"，但以百万医疗险为代表的补充医疗险仅服务"投保后患病"人群；惠民保作为极少 数接受恶性肿瘤患者投保的险种，既往癌症的相关治疗费用也往往被排除在赔付之外。 与此同时，保费规模增速仍然低于市场预期的健康险行业也正在寻找新的增量，供需双方的诉求在一 类小众"带病体"险种中产生交集——肿瘤复发险。 不过，创新的落地举步维艰。"产品设计和定价都很艰难。更难的是，好不容易推出的产品卖不出 去。"一名专病保险开发的保司人士对第一财经表示。 "卖不出去"的背后有多重原因，其中最为迫切和根本的 ...

Core Insights - The health insurance market in China is approaching a premium scale of nearly 1 trillion yuan in 2024, reversing a trend of slowing growth seen in the previous three years, yet the market for individuals with pre-existing conditions remains largely excluded [2][3] - The industry is under pressure to transform from insuring healthy individuals to focusing on the health of all individuals, particularly those with pre-existing conditions, as regulatory bodies encourage innovation in product offerings [3][4] - Approximately 400 million people in China belong to the "sick population," contributing about 60% of medical expenses but only accounting for around 5% of commercial insurance premiums [2][4] Market Dynamics - The health insurance sector is experiencing a shift towards accommodating individuals with pre-existing conditions, with recent regulatory encouragement for insurance companies to develop products that include these groups [4][5] - The lack of long-term, high-quality data in China's health insurance market has hindered the ability of insurance companies to accurately assess and price risks associated with different health statuses [5][6] - The market for insurance products catering to individuals with pre-existing conditions has seen limited growth, with the total premium for such insurance remaining around 50 billion yuan, primarily sourced from group insurance and community-based health plans [6][7] Product Innovation - Recent developments in insurance products have seen a transition from short-term to long-term medical insurance plans, which promise continuity of coverage and better risk management for individuals transitioning from healthy to sick [7][9] - The introduction of specialized insurance products targeting specific health conditions, such as chronic diseases and cancer, is gradually expanding the market, although significant gaps in coverage for high-risk individuals remain [8][9] - The insurance industry is exploring new ways to innovate in product design, including leveraging medical data to enhance pricing accuracy and risk assessment capabilities [9][10] Challenges and Opportunities - The integration of innovative drugs and therapies into health insurance coverage remains a challenge, with insurance companies often lacking precise evaluations of the costs and usage rates of these treatments [10][11] - The disparity between the needs of patients requiring innovative treatments and the insurance products available highlights a significant gap in the market that needs to be addressed [11][12] - The willingness of the sick population to pay higher premiums for insurance coverage is crucial for the sustainability of these products, as high-risk individuals typically face higher costs [12]

Core Viewpoint - The "Hui Min Bao" insurance model, particularly the "Hu Hui Bao" in Shanghai, is gaining traction with over 1 million reservations on its first day, indicating strong market interest and potential for sustainable operation [1][2]. Group 1: Product Overview - "Hui Min Bao" is a one-year insurance product that can be participated in by both property and life insurance companies [2]. - The model aims for a break-even, low-profit strategy, where most premiums are converted into claims, as evidenced by the 8.5 billion yuan in premiums and 6 billion yuan in claims from last year [1]. Group 2: Market Dynamics - Concerns about the sustainability of the "Hui Min Bao" model have been alleviated by its ability to adapt through rate adjustments and expanded coverage, which helps mitigate operational risks [2][3]. - The growth of health insurance, including "Hui Min Bao," is notable amid the challenges faced by traditional life and critical illness insurance due to the ongoing pandemic [3]. Group 3: Challenges and Recommendations - Issues such as multiple "Hui Min Bao" products in some cities and the risk of low participation rates leading to high claims need to be addressed to avoid a "death spiral" scenario [2]. - Government support and regulatory oversight are essential to prevent unhealthy competition and ensure that "Hui Min Bao" serves its intended purpose of providing affordable coverage [3].