肿瘤复发险有需求没销路，上海探索“商保进医院”

Core Viewpoint - The article discusses the challenges and opportunities in the commercial health insurance market in China, particularly focusing on cancer recurrence insurance, amidst the backdrop of rising out-of-pocket expenses for cancer treatment and the evolving healthcare landscape [2][3]. Group 1: Market Dynamics - China's healthcare insurance system has made significant progress in coverage, but patients still face high out-of-pocket costs, with some cancer treatments having self-payment ratios nearing or exceeding 50% [2]. - The demand for commercial health insurance, particularly for cancer patients, is increasing as the "cancer survivor" population grows [2]. - Commercial health insurance products, such as million medical insurance, primarily serve those who fall ill after purchasing the policy, while few products accept patients with a history of cancer [2][4]. Group 2: Product Development Challenges - The development of specialized disease insurance, such as cancer recurrence insurance, faces difficulties in product design and pricing, with a significant gap between market expectations and actual growth [4][5]. - Specialized disease insurance is tailored for specific patient groups, but the market for such products is still relatively small, with only a few billion in scale compared to hundreds of billions for broader medical insurance [4][5]. - The pricing of recurrence insurance is complicated by the need to balance affordability for patients with the necessity of covering potential risks [5][6]. Group 3: Sales and Distribution Issues - The primary challenge for insurance companies is not just pricing but also effectively reaching consumers to sell these products [6]. - Traditional sales channels are limited, and the online sales of recurrence insurance are rare, complicating the distribution process [6][7]. - The small target population for recurrence insurance, such as the estimated 6,000 breast cancer recurrence cases in Shanghai annually, makes it difficult to achieve significant sales volume [6][7]. Group 4: Collaboration and Data Utilization - Successful operation of specialized insurance products requires collaboration with hospitals and pharmaceutical companies to ensure patients receive timely and appropriate treatment [7][8]. - Access to comprehensive patient data from medical institutions is crucial for developing effective insurance products, as it helps in assessing risks and setting premiums [9][10]. - Recent policy changes in Shanghai have begun to facilitate data sharing between medical institutions and insurance companies, which could enhance the development of specialized insurance products [9][10][11]. Group 5: Future Outlook - The market for recurrence insurance is expected to grow, but its expansion will depend on the ability to cover more types of cancer and other diseases with similar recurrence risks [12][13]. - The collaboration between insurance companies and healthcare providers is essential for creating a sustainable model that benefits all parties involved, including patients, hospitals, and pharmaceutical companies [12][13].