阿尔法工场金融家 . 追踪保险银行业圈内动态，剖析最新风向，分享有料、有价值的"内行人"洞察见解。 以下文章来源于阿尔法工场金融家 ，作者金妹妹 导语：AIG等巨头正与Palantir、Anthropic结盟，抢占"AI军火库"。 告别规模驱动的黄金十年，全球保险业正集体驶入一个增长放缓、利润承压的深水区。 过去几年影响保险业的外部力量并未消退，经济波动与地缘政治摩擦持续叠加， 侵蚀着传统利差损益模式；气候变化带来的巨灾风险，直击财产 险公司的盈利底线。 与此同时，行业内部的边界不断被技术、 渠道和资本重塑；科技公司、私募股权机构等"新玩家"携资本与技术优势入场，不断向保险领域渗透。 保险业的竞争范式正在发生根本性转移，从依赖牌照与渠道的规模博弈，转向围绕技术、资本与服务能力的深度变革。 12月3日，德勤发布《2026年全球保险业展望》报告，从非寿险、寿险与年金险、团险到AI技术、客户体验与税制变动等方面，系统展示了行业 正在经历的深层变革，勾勒出未来几年保险生态的演变路径。 其一，是非寿险领域，围绕技术与成本演变的"科技战"。 非寿险行业在走出承保难周期后，再度进入压力叠加阶段。全球非寿险保费增速在2026 ...

告别规模驱动的黄金十年，全球保险业正集体驶入一个增长放缓、利润承压的深水区。 过去几年影响保险业的外部力量并未消退，经济波动与地缘政治摩擦持续叠加，侵蚀着传统利差损益模式；气候变化带来的巨灾风险，直击财产险公司的 盈利底线。 与此同时，行业内部的边界不断被技术、渠道和资本重塑；科技公司、私募股权机构等"新玩家"携资本与技术优势入场，不断向保险领域渗透。 保险业的竞争范式正在发生根本性转移，从依赖牌照与渠道的规模博弈，转向围绕技术、资本与服务能力的深度变革。 12月3日，德勤发布《2026年全球保险业展望》报告，从非寿险、寿险与年金险、团险到AI技术、客户体验与税制变动等方面，系统展示了行业正在经历 的深层变革，勾勒出未来几年保险生态的演变路径。 其一，是非寿险领域，围绕技术与成本演变的"科技战"。 非寿险行业在走出承保难周期后，再度进入压力叠加阶段。全球非寿险保费增速在2026年预计继续放缓，美国市场的承保成本率将从2024年的97.2%上升 至2026年的99%，利润空间被进一步压缩。 推动成本上行的因素来自多个维度：关税上调、供应链中断、劳动力短缺和材料价格上涨，使汽车保险与家财险赔付成本持续攀升；贸易政 ...

这份报告是由德勤金融服务行业研究中心撰写的《2026年全球保险行业展望》，旨在分析全球保险行业在2026年面临的主要趋势、挑战和机遇。报告涵盖了 财产与意外伤害险（P&C）、寿险及年金险（L&A）、团险等多个领域，并探讨了人工智能（AI）在保险行业的应用、客户体验提升、政策变化等方面的 内容。以下是对报告核心内容的详细解读： 一、引言 - 市场环境：全球经济波动加剧，地缘政治不稳定，自然灾害频发，保险行业面临高度不确定性。 - 行业变革：客户期望快速变化，分销渠道整合，技术革新不断，保险公司需主动调整运营模式和增长路径。 二、财产与意外伤害险（P&C）：多轮驱动破局 - 市场趋势：全球保费增长放缓，市场竞争加剧，费率增长动能减弱。新兴市场受经济增长放缓影响，保费增速回落。 - 技术应用：AI和地理空间分析技术助力保险公司精准预测并降低多险种损失。监管机构支持数据驱动的风险识别方法。 - 资本策略：保险公司需采用更敏捷的资本模式，通过第三方再保险管理自留风险，利用巨灾债券等工具提升资本灵活性。 三、寿险及年金险（L&A）：以战略联盟应对增长放缓 - 市场趋势：全球寿险业务增长趋缓，发达市场增长疲弱，新兴市场中端 ...

Core Viewpoint - The article discusses the recent establishment of a commercial health insurance (CHI) innovative drug directory in China, marking a significant shift towards a dual-track payment system for innovative drugs, alongside the traditional national medical insurance system [4][6][12]. Group 1: Introduction of Commercial Health Insurance Innovative Drug Directory - The CHI innovative drug directory focuses on high-innovation, clinically valuable drugs that cannot be included in the basic medical insurance directory due to their high costs [4][6]. - This directory aims to address the multi-layered payment challenges for innovative drugs, with the implementation of supportive measures still pending [4][6]. Group 2: Transition to Dual-Track Payment System - The introduction of the CHI innovative drug directory represents a historic transition from a single-track medical insurance system to a dual-track system combining both national medical insurance and commercial health insurance [6][12]. - The new policy is expected to alleviate the financial pressure on the basic medical insurance fund while enhancing access to innovative drugs [6][12]. Group 3: Current Challenges in Commercial Health Insurance - There are significant disparities in coverage provided by commercial health insurance for innovative drugs, with only 7.7% of the market being covered by CHI [7]. - The current commercial health insurance market is small, and expanding its scale is a pressing issue, with group insurance being a potential avenue for growth [12][13]. Group 4: Implementation and Operational Challenges - The successful implementation of the CHI innovative drug directory requires collaboration among the National Medical Insurance Administration, pharmaceutical companies, and insurance providers [10]. - There are concerns regarding the ability of existing commercial health insurance products, such as "Hui Min Bao," to adequately cover innovative drugs due to low reimbursement rates [11][12]. Group 5: Need for Improved Payment Mechanisms - The article emphasizes the need for improved payment mechanisms, such as direct settlement systems, to facilitate the integration of innovative drugs into hospitals [16]. - Establishing a collaborative mechanism between medical insurance and commercial health insurance is crucial for effective implementation and data sharing [16].

Core Insights - The insurance industry is experiencing a price war driven by new entrants competing for market share, leading to a paradox where increasing premium rates results in poor sales, while maintaining low rates limits coverage expansion [1][4]. Group 1: Market Dynamics - The trend of high-end medical insurance products being downgraded to mid-range options reflects a shift in focus among insurers, with many companies now offering mid-tier products that closely resemble their high-end counterparts in terms of coverage [3]. - The competition in the "pre-existing conditions" insurance market is intensifying, with many insurers expanding their product offerings to include more comprehensive coverage while struggling to balance premium growth with coverage responsibilities [2][6]. Group 2: Pricing Strategies - Insurers are facing challenges in maintaining premium rates due to increased competition, which is forcing them to innovate in areas such as actuarial science and service delivery to remain competitive [5]. - The introduction of low-premium, no-health-disclosure products indicates a shift towards more accessible insurance options, although this raises concerns about the sustainability of such pricing models [4][7]. Group 3: Risk Management - Despite the expansion of coverage responsibilities outpacing premium growth, the perceived operational risks for insurers are not as high as the public might believe, thanks to improved data analytics and risk assessment capabilities [6][7]. - The integration of healthcare data and advancements in insurance technology, particularly AI, are enabling insurers to better evaluate risks and adjust pricing dynamically, which is crucial for managing the balance between affordability and coverage [7][8]. Group 4: Future Considerations - The industry faces ongoing challenges in addressing the diverse needs of consumers with pre-existing conditions, necessitating further exploration of differentiated pricing strategies to avoid a one-size-fits-all approach [8].

Core Viewpoint - The Chinese commercial health insurance market is showing signs of recovery after three years of slow growth, with expectations to surpass 1 trillion yuan this year. However, a structural transformation is urgently needed, shifting from "insuring healthy people" to "insuring people's health" [1][4]. Group 1: Market Dynamics - The "sick body" insurance market, which covers individuals with pre-existing conditions or chronic diseases, is crucial for building a multi-tiered medical security system and promoting innovative drug development [1][4]. - In August, Shanghai introduced measures to encourage insurance companies to include elderly individuals and those with pre-existing conditions in their coverage, aiming for high-quality development of commercial health insurance [1][3]. - The group insurance market, while larger in absolute scale, has been facing challenges such as increased claims ratios and slowing growth rates due to rising medical costs and competitive pressures [3][6]. Group 2: Financial Contributions - In 2024, individual health insurance products like "Hui Min Bao" and "Million Medical Insurance" contributed nearly 40% of the commercial insurance payments for innovative drugs, totaling approximately 4.5 billion yuan, while group insurance contributed less than 10%, around 1 billion yuan [3][5]. - The annual premium scale of group insurance has exceeded 100 billion yuan, accounting for nearly 30% of the commercial health insurance market [4][5]. Group 3: Challenges and Opportunities - The group insurance market is experiencing a "survival" focus rather than "responsibility expansion," with claims ratios reaching 70%-80% due to the nature of the products [3][6]. - The market is facing a "two-eighty rule," where 20% of large corporate clients pay 80% of the premiums, indicating a concentration of demand among healthier, higher-paying employees [5][6]. - There is a growing recognition that reform in group insurance is necessary to accommodate innovative drug coverage, as current products are primarily designed for small, frequent claims [8][9]. Group 4: Future Outlook - The shift towards group insurance as a more stable option for medical coverage is seen as more feasible than relying on individual payments, especially in the context of rising healthcare costs and economic pressures on companies [10].

Group 1 - The core viewpoint of the article is that after three years of slowdown, the Chinese commercial health insurance market is showing signs of recovery and is expected to surpass the trillion yuan mark this year, but structural transformation is urgently needed from "insuring healthy people" to "insuring people's health" [2][3] - The development of insurance for the "sick population" is crucial for building a multi-tiered medical security system and for the growth of innovative drugs [3] - Shanghai has taken the lead in promoting high-quality development of commercial health insurance with measures that encourage insurance institutions to include elderly individuals and those with pre-existing conditions in their coverage [3] Group 2 - In 2024, individual health insurance products like "Hui Min Bao" and "Million Medical Insurance" contributed nearly 40% of commercial insurance payments for innovative drugs, totaling approximately 4.5 billion yuan, while group insurance accounted for less than 10%, around 1 billion yuan [5][7] - The group insurance market, while larger in absolute scale, has been facing challenges such as a focus on common illnesses rather than major illness reimbursements, leading to a high claims ratio of 70%-80% [5][6] - The annual premium scale of group insurance has exceeded 100 billion yuan, accounting for nearly 30% of the commercial medical insurance market [6] Group 3 - The contribution of group insurance to innovative drug payments is limited, with a significant gap in coverage for special drugs, which are typically high-cost and effective treatments for severe diseases [7] - The group insurance market is characterized by a "20-80 rule," where 20% of large corporate clients pay 80% of the premiums, indicating a strong demand for high-value drugs among these clients [7][9] - The average claims ratio for group insurance is expected to remain high, around 80%, due to rising medical costs and increased health awareness among employees [9] Group 4 - Reform of group insurance is necessary to incorporate innovative drug coverage, as the current model leads to overuse of small medical claims and insufficient protection for major illnesses [10][11] - The commercial health insurance market is entering a phase where individual purchasing power is limited, making it more feasible to upgrade medical coverage based on group insurance rather than relying on individual payments [11]

Core Viewpoint - The Chinese commercial health insurance market is showing signs of recovery after three years of slowdown, with expectations to surpass a trillion yuan in scale this year. However, a structural transformation is necessary, shifting from "insuring healthy people" to "insuring people's health" [3]. Group 1: Market Dynamics - The development of insurance for individuals with pre-existing conditions or chronic diseases, referred to as "sick population," is crucial for building a multi-tiered medical security system and promoting innovative drug development [3]. - In 2024, individual insurance products like "Hui Min Bao" and "Million Medical Insurance" contributed nearly 40% of commercial insurance payments for innovative drugs, totaling approximately 4.5 billion yuan, while group insurance contributed less than 10%, around 1 billion yuan [5][8]. - The group insurance market, despite its larger absolute scale, is primarily focused on common illnesses rather than major illnesses, with a payout ratio typically between 70% and 80% [5][6]. Group 2: Policy Support and Innovation - Shanghai's "New 18 Measures" encourages insurance institutions to include elderly individuals and those with pre-existing conditions in their coverage, aiming to foster high-quality development of commercial health insurance [3][6]. - The group insurance market is facing challenges such as slowing growth rates and rising payout ratios, necessitating innovative product development to support the payment for innovative drugs [6][9]. Group 3: Challenges in Group Insurance - The group insurance market is experiencing a "two-eight rule," where 20% of large corporate clients account for 80% of the premiums, indicating a concentration of health-conscious and financially capable clients [9]. - Due to economic pressures, many small and medium-sized enterprises are reducing their group insurance budgets, impacting the overall market dynamics [9][10]. - The average payout ratio for group insurance is expected to remain high, around 80%, due to increased medical expenses and a rise in the number of employees with chronic conditions [11][12]. Group 4: Future Directions - Reform of group insurance is essential to accommodate the coverage of innovative drugs, as the current model may lead to overuse of small medical expenses and insufficient coverage for major illnesses [13][14]. - The shift towards upgrading medical insurance based on group insurance fundamentals is seen as a more feasible approach compared to direct individual payments, especially in a challenging economic environment [14].

Core Insights - The Chinese commercial health insurance market is showing signs of recovery after three years of slowdown, with expectations to surpass the trillion yuan mark this year [1] - A structural transformation is necessary, shifting from "insuring healthy people" to "insuring people's health," particularly focusing on the large population with pre-existing conditions or chronic diseases [1] - Shanghai has introduced measures to promote high-quality development of commercial health insurance, encouraging the inclusion of elderly and chronic disease patients in coverage [1] Group 1: Market Dynamics - The group insurance market is larger in absolute terms but has different characteristics compared to individual insurance products, focusing on common illnesses rather than critical illness reimbursement [2] - The group insurance market faces challenges such as rising claims ratios (70%-80%) and slowing growth due to increased operational pressures on companies [2][4] - The total annual premium scale of group insurance in China has exceeded 100 billion yuan, accounting for nearly 30% of the commercial medical insurance market [3] Group 2: Innovation and Coverage - Group insurance has the potential to cover a significant portion of the "sick population," which is crucial for the sales of innovative drugs and medical devices [4] - There is a notable gap in coverage for outpatient medications under individual insurance products, prompting innovative drug companies to explore group insurance as a viable market [4] - The group insurance market is characterized by a "Pareto principle," where 20% of large corporate clients contribute to 80% of the premiums, indicating a concentration of health-conscious employees who are more likely to accept high-value medical treatments [4] Group 3: Challenges and Reforms - The rising medical costs and the need for reform in group insurance products are pressing issues, as current models may not adequately cover innovative drug responsibilities [6] - The average claims ratio for group insurance is expected to remain high, potentially reaching 80%, which poses sustainability challenges for insurers [5][6] - There is a call for a shift towards a "secondary reimbursement" model in group insurance to address the increasing frequency of claims for minor ailments, which could lead to overuse of benefits [6][7]

Core Insights - The Chinese commercial health insurance market is showing signs of recovery after three years of slowdown, with expectations to surpass the trillion yuan mark this year [1] - A structural transformation is necessary, shifting from "insuring healthy people" to "insuring people's health," particularly focusing on the large population with pre-existing conditions or chronic diseases [1] - Shanghai has introduced measures to promote high-quality development of commercial health insurance, encouraging the inclusion of elderly and chronic disease patients in coverage [1] Group 1: Market Dynamics - In the past year, innovative drug companies have expressed interest in expanding their market through group insurance channels, despite the group insurance market being larger but facing challenges such as low reimbursement for common diseases [3][4] - The group insurance market has a significant potential for covering innovative drug costs, with the annual premium scale exceeding 100 billion yuan, accounting for nearly 30% of the commercial medical insurance market [4][5] - The contribution of group insurance to the payment for innovative drugs is currently low, at around 10 billion yuan, indicating a gap in coverage for specialized drugs [5] Group 2: Challenges and Opportunities - The group insurance market is experiencing pressure from rising claims and a slowdown in premium growth, with a compound annual growth rate of about 11% from 2018 to 2023, significantly lower than that of individual insurance products [6][7] - The average claims ratio for group insurance is expected to remain high, around 80%, due to increased healthcare utilization and employee health awareness [8] - There is a pressing need for reform in group insurance products to accommodate innovative drug coverage, as current structures may lead to overuse of benefits for minor ailments [9][10]