Core Insights - The report highlights a significant health insurance gap for the "sick population" in China, driven by aging demographics, the younger onset of chronic diseases, and advancements in medical technology that extend patient lifespans [1][3][18] Group 1: Health Insurance Gap - The average medical expenditure for the sick population is 87,625 yuan, which is 2.1 times the annual disposable income of residents [5] - Nearly 30% of the sick population is denied insurance coverage due to health disclosures [1][8] - By the end of 2024, the population aged 60 and above in China is expected to exceed 300 million, accounting for 22% of the total population, with 75% of this group suffering from at least one chronic disease [3][4] Group 2: Rising Chronic Diseases - The incidence of type 2 diabetes among individuals aged 15-39 has doubled from 1990 to 2021, making it difficult for many young people to obtain health insurance at standard rates [4][11] - The five-year survival rate for cancer patients has improved from 33.3% a decade ago to 43.7%, indicating a growing need for insurance among long-term survivors [4][14] Group 3: Financial Burden and Willingness to Pay - Over 60% of major disease patients pay more than 100,000 yuan out-of-pocket for medical expenses, with the average monthly medication cost for the sick population at 526.85 yuan [7][8] - 75.4% of the sick population is willing to pay additional premiums for coverage of existing conditions, with an average annual willingness to pay around 4,049 yuan [6][8] Group 4: Insurance Product Insights - The report indicates a significant gap in insurance products for specific demographics, such as young adults and mothers, with many expressing a clear need for coverage but facing limited options [10][12] - Innovations in insurance products are emerging, including simplified health disclosures and coverage for pre-existing conditions, which are becoming trends in the market [14][15] Group 5: Recommendations for Development - The report suggests that government policies should support the inclusion of sick population insurance in inclusive insurance categories and promote data sharing for precise pricing [17] - Companies are encouraged to invest resources into developing targeted products for the sick population and to leverage big data and AI for underwriting and risk management [17][18]

Core Viewpoint - The health insurance industry in China is facing a transformation as it seeks to expand coverage for individuals with pre-existing conditions, despite the current market being largely focused on healthy individuals. The need for innovative products that cater to the "sick population" is becoming increasingly urgent as the market approaches a premium scale of nearly 1 trillion yuan in 2024, with approximately 4 billion people classified as having pre-existing conditions contributing significantly to medical expenses but only a small fraction of insurance premiums [3][4][6]. Group 1: Market Dynamics - In 2024, China's health insurance premium scale is nearing 1 trillion yuan, reflecting a reversal in growth trends from previous years [3]. - Approximately 4 billion people in China belong to the "sick population," contributing about 60% of medical expenses but only 5% of commercial insurance premiums [3][6]. - The health insurance market has historically focused on healthy individuals, leading to a lack of tailored products for those with pre-existing conditions [7][8]. Group 2: Regulatory and Policy Changes - Recent calls from financial regulatory bodies aim to shift health insurance from "insuring healthy individuals" to "insuring individuals' health," encouraging the development of high-value innovative products [4][6]. - Local governments in cities like Shanghai and Chongqing are promoting insurance products that include coverage for the elderly and those with chronic conditions [6][8]. - The insurance industry is awakening to the need for change, with regulatory support pushing for more inclusive insurance offerings [5][7]. Group 3: Product Innovation and Challenges - The market has seen some product innovation, with insurance companies beginning to offer policies that relax pre-existing condition restrictions, such as "no health declaration" products [3][9]. - Despite these innovations, the scale of insurance for individuals with pre-existing conditions remains limited, with the market for such insurance still around 50 billion yuan [8][9]. - The evolution of insurance products from short-term to long-term coverage is seen as a positive step, allowing for better risk management and customer retention [9][11]. Group 4: Future Directions - The next steps for the sick population insurance market involve enhancing the breadth and depth of coverage, particularly for innovative drugs and therapies [12][14]. - The insurance industry is encouraged to transition from being passive payers to active participants in the healthcare ecosystem, integrating with medical and pharmaceutical services [14]. - The key to successful development in this sector lies in aligning risk with pricing, as high-risk individuals may be unwilling to pay higher premiums, which could hinder product viability [14].