医保商保协同更好惠民生

Core Viewpoint - The collaboration between basic medical insurance and commercial health insurance in China is advancing significantly, with new measures and systems being implemented to enhance efficiency and accessibility for patients [1][2][3][4]. Group 1: Policy Developments - The first national "medical insurance + commercial insurance" clearing settlement center has begun operations in Beijing, reducing the time lag in claims settlement between the two systems [1]. - A joint initiative by the Shanghai Financial Regulatory Bureau and seven other departments has been launched to promote the high-quality development of commercial health insurance, focusing on payment mechanisms and data sharing [1][2]. - The initial review of a new commercial insurance innovative drug directory has been completed, featuring several high-priced cancer drugs, providing new payment avenues for innovative medications [1][2]. Group 2: Market Statistics - As of 2024, the number of participants in basic medical insurance is 1.326 billion, maintaining a coverage rate of 95%, with total fund expenditures reaching 2.97 trillion yuan [2]. - The commercial health insurance market is experiencing rapid growth, with original insurance premium income reaching 977.3 billion yuan in 2024, a year-on-year increase of 8.2% [2]. Group 3: Operational Improvements - The new clearing settlement center allows patients to use their medical insurance code for basic reimbursement and then directly use their commercial insurance code for remaining payments, streamlining the reimbursement process [2]. - The National Medical Insurance Administration is exploring synchronized settlement between basic medical insurance and commercial health insurance, aiming to reduce patient burden through data sharing [3]. Group 4: Future Directions - The collaboration between basic medical insurance and commercial health insurance is expected to enhance drug accessibility, foster innovation in the pharmaceutical industry, and support the development of commercial health insurance [4]. - There are plans to explore the coordination of coverage areas, allowing commercial health insurance to complement basic medical insurance, particularly through the establishment of an innovative drug directory [4]. - The industry is transitioning from a single-track payment system to a multi-channel payment mechanism, although challenges remain in establishing payment access mechanisms for innovative drugs and developing pricing systems for insurance and pharmaceuticals [4].