Guosen: Our country's commercial health insurance revenue is expected to rise in the future. It is suggested to pay attention to leading health insurance companies in the industry.

Guosen released a research report stating that by 2025, the industry will accelerate the construction of commercial health insurance under medical insurance payments, and it is expected that corresponding measures will further enhance the value contribution of commercial health insurance in China. In addition, from the company's perspective, it is expected that the expansion of health insurance scale in the future will help optimize the liability structure of life insurance business, reduce reliance on interest margin products, dynamically adjust interest margin loss risks, and stabilize the value level of insurance companies. Under neutral assumptions, the bank expects that by 2028, China's commercial health insurance premium income is expected to increase from 970 billion yuan to 1.40 trillion yuan. It is recommended to pay attention to the leading health insurance companies in the industry. Guosen's main points are as follows: The intensification of aging and the slowdown in the growth of medical insurance income increase the necessity of medical insurance payment reform According to the National Health Commission's forecast, it is expected that around 2035, China's population aged 60 and above will exceed 400 million, accounting for over 30% of the total population, entering a stage of severe aging. In addition, the overall operation of domestic medical insurance funds is good, but in recent years, the expenditure side has expanded faster than the income side, increasing the operational pressure of medical insurance. DRG and DIP both set payment standards in advance, grouping patients according to certain rules, and providing packaged payment for medical services within a fixed budget, motivating hospitals to strictly implement standardized clinical pathways for diagnosis and treatment, reduce unnecessary examinations and treatments, thereby reducing medical costs and improving efficiency. Significant changes in the structure of medical expenses drive the evolution of commercial health insurance After the DRG/DIP reform, the average hospitalization cost per capita has decreased significantly, resulting in patients' out-of-pocket expenses significantly lower than the deductible amount of ordinary commercial medical insurance, making it difficult for ordinary million-dollar medical insurance to meet basic medical insurance needs. In 2023, the average hospitalization cost per capita of residents' medical insurance decreased by 5% year-on-year, while outpatient costs increased by 5.5% year-on-year, but million-dollar medical insurance still focuses on hospital reimbursement, with a general lack of outpatient protection, thereby weakening the practicality and attractiveness of products. In addition, the data sharing mechanism between medical insurance and commercial insurance in China is not perfect, affecting the precise underwriting, pricing, and claims efficiency of insurance companies, leading to an increased risk of potential overpayment by commercial insurance companies. The role of universal insurance is strengthened, and the supply of high-end medical insurance increases Currently, China has a large population of chronic diseases and non-standard individuals. Against the background of medical insurance payment reform, it is difficult to meet the medium and long-term medical needs. The bank believes that against the backdrop of the current change in the medical insurance payment landscape, the medical supplement function of commercial health insurance is further strengthened, and commercial insurance is expected to usher in opportunities for stable and long-term development. The supplementary function of universal health insurance is highlighted, complementing medical insurance by expanding outpatient coverage, covering non-standard individuals, and developing in a complementary manner with basic medical insurance. High-end medical insurance, with the advantages of wide coverage, high degree of service integration, and precise positioning of customer groups, becomes the core carrier to meet the quality medical needs. Medical insurance reform compresses the payment elasticity of basic medical insurance, driving commercial health insurance to transition to "service-oriented products" Looking ahead, the core opportunities for commercial health insurance lie in the two ends of "product and service upgrade" and "data and technology empowerment." (1) Products and services: Increase the development of products for non-standard individuals, improve product supply; build a service ecosystem to reduce payout risks through front-end intervention. (2) Data interoperability: The construction of commercial insurance directories integrates industry health insurance resources, promotes standardized development in the industry, and aims to transition from "passive payment" to "active health management." In the future, commercial insurance directories need to further strengthen dynamic adjustment mechanisms, explore linkage with medical insurance directories, deepen the integration of health management services, fill the gaps in multi-level medical security, promote the integration of "medicine + health + insurance" ecosystems. Risk warnings: Premium growth below expectations; fluctuations in payout levels; delays in data sharing initiatives, etc.