Core Viewpoint - Shanghai has introduced a new set of 18 measures aimed at promoting the high-quality development of commercial health insurance to support innovation in the biopharmaceutical industry, focusing on enhancing the multi-payment mechanism, particularly in commercial health insurance [1][2]. Group 1: Policy Overview - The new measures are a deepening upgrade of the previous "28 measures" and represent the first systematic policy document in China to construct a dual empowerment mechanism between commercial health insurance and biopharmaceutical innovation [1]. - The measures address long-standing issues of insufficient collaboration among multiple departments in the development of commercial health insurance, providing support and guidance for the standardized development and innovation of health insurance products [1][2]. Group 2: Data Sharing and Product Development - The new policies emphasize the establishment of a data-sharing mechanism among medical institutions, pharmaceutical companies, and commercial insurance companies to enhance product development and actuarial needs [2][3]. - The measures support the development of various health insurance products, including group insurance, welfare insurance, nursing insurance, and specialized products for specific populations, particularly focusing on the needs related to innovative drugs and medical devices [2][3]. Group 3: Targeted Support for Specific Populations - The new measures encourage insurance companies to include elderly individuals, those with pre-existing conditions, and chronic patients in their coverage, thereby broadening the service population of commercial health insurance [4]. - There is a focus on providing diversified customized services to new citizens and specific groups in new industries and business formats [4]. Group 4: Purchasing and Funding Mechanisms - The measures propose a matching engine for health insurance products based on individual profiles and characteristics, facilitating easier access to insurance products for consumers [5]. - Employers are encouraged to purchase group health insurance for employees, with provisions for shared premium payments between employers and employees, utilizing personal account balances for premium payments [5]. Group 5: Claims and Payment Innovations - The new measures aim to enhance the application of medical insurance data in commercial insurance settlements, optimizing the synchronization of settlements between medical insurance and commercial insurance [6]. - There is a focus on improving the accessibility and affordability of innovative drugs through collaborative mechanisms involving commercial insurance, medical insurance, charitable organizations, and pharmaceutical companies [6].
上海“新18条”鼓励商保创新产品开发 提升创新药械可及性
Di Yi Cai Jing·2025-08-06 14:58