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].

2025.08.31 本文字数：2889，阅读时长大约5分钟 作者 |第一财经 吴斯旻 【编者按】 经历了三年的增长放缓后，中国商业健康保险市场在去年展现出回暖态势，并有望在今年突 破万亿规模大关。但当市场重拾增长动能后，结构性转型依然迫在眉睫——从"保健康人"转 向"保人健康"。 "保人健康"即让商保覆盖数量庞大的、患有既往症或慢性病的"带病体"人群，而"带病体"保 险的成长既事关多层次医疗保障体系构建，也事关创新药发展。 今年8月，上海率先发布《关于促进商业健康保险高质量发展助力生物医药产业创新的若干 措施》（下称"新十八条"），提出"鼓励保险机构按照风险可控、商业可持续原则，将老年 人、既往症和慢性病人群纳入保障范围"。 "带病体"保险市场的发展相较于传统健康险产品更需要政策端的支持。那么，上海是如何集 多部门合力，推动市场差异化创新？当更多"带病体"被纳入商保保障范围内，对于创新药械 企业销售"放量"作用几何？从个险到团险，从普惠性保险到中高端保险，上海如何构建多层 次多元化的健康险市场？第一财经近期就这些问题展开调研和探讨。 （2024年，惠民保和百万医疗险贡献了商保对创新药械支付的近四成金额，支付 ...

本文字数：2889，阅读时长大约5分钟 2025.08. 31 （2024年，惠民保和百万医疗险贡献了商保对创新药械支付的近四成金额，支付规模合计约45亿元，团险的贡献额占比不到一 成，10亿元左右。摄影记者/任玉明） 作者 | 第一财经 吴斯旻 【编者按】 经历了三年的增长放缓后，中国商业健康保险市场在去年展现出回暖态势，并有望在今年突破万亿规模大 关。但当市场重拾增长动能后，结构性转型依然迫在眉睫——从"保健康人"转向"保人健康"。 "保人健康"即让商保覆盖数量庞大的、患有既往症或慢性病的"带病体"人群，而"带病体"保险的成长既 事关多层次医疗保障体系构建，也事关创新药发展。 今年8月，上海率先发布《关于促进商业健康保险高质量发展助力生物医药产业创新的若干措施》（下 称"新十八条"），提出"鼓励保险机构按照风险可控、商业可持续原则，将老年人、既往症和慢性病人群 纳入保障范围"。 "带病体"保险市场的发展相较于传统健康险产品更需要政策端的支持。那么，上海是如何集多部门合力， 推动市场差异化创新？当更多"带病体"被纳入商保保障范围内，对于创新药械企业销售"放量"作用几何？ 从个险到团险，从普惠性保险到中高端保 ...

【编者按】 经历了三年的增长放缓后，中国商业健康保险市场在去年展现出回暖态势，并有望在今年突破万亿规模 大关。但当市场重拾增长动能后，结构性转型依然迫在眉睫——从"保健康人"转向"保人健康"。 "保人健康"即让商保覆盖数量庞大的、患有既往症或慢性病的"带病体"人群，而"带病体"保险的成长既 事关多层次医疗保障体系构建，也事关创新药发展。 今年8月，上海率先发布《关于促进商业健康保险高质量发展助力生物医药产业创新的若干措施》（下 称"新十八条"），提出"鼓励保险机构按照风险可控、商业可持续原则，将老年人、既往症和慢性病人 群纳入保障范围"。 "带病体"保险市场的发展相较于传统健康险产品更需要政策端的支持。那么，上海是如何集多部门合 力，推动市场差异化创新？当更多"带病体"被纳入商保保障范围内，对于创新药械企业销售"放量"作用 几何？从个险到团险，从普惠性保险到中高端保险，上海如何构建多层次多元化的健康险市场？第一财 经近期就这些问题展开调研和探讨。 "近一年多来，不少创新药企业都对我们提出过通过团险渠道拓展市场的想法。"一名商业健康险产业界 人士对第一财经记者表示。 这样的想法有其合理性。尽管团险市场的绝对规模 ...

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]

Core Viewpoint - The report from CITIC Securities indicates that policy-driven standardization will contribute positively to the growth of the diversified payment system in the pharmaceutical industry, enhancing consumer awareness of commercial health insurance and providing additional growth opportunities for the sector [1] Group 1: Policy Impact - The gradual standardization of the industry through various policies is expected to improve the completeness of urban commercial health insurance products like Huiminbao, which will likely enhance residents' consumption awareness of commercial insurance [1] - The introduction of products such as Huiminbao and group insurance is anticipated to accelerate the incubation of related innovative business models [1] Group 2: Long-term Growth Prospects - The long-term outlook for the innovative pharmaceutical and medical device industry chain is positive, as the development of commercial insurance is expected to gradually remove restrictions, leading to significant improvements in payment and distribution channels [1] - This improvement is projected to provide additional market space for relevant companies in the innovative pharmaceutical and high-end medical sectors [1]