商保支付在京破局 十八条举措欲破数据壁垒

Core Viewpoint - The release of the "Beijing Commercial Health Insurance Eighteen Measures" aims to enhance the quality and development of commercial health insurance in Beijing, addressing long-standing issues in the industry and promoting data sharing and innovation in insurance products [1][2]. Group 1: Data Sharing and Innovation - The measures emphasize the establishment of a data-sharing mechanism for medical expenses, health check-ups, and imaging tests, which is expected to resolve the lack of actuarial data in product design [2][3]. - The policy encourages the development of innovative insurance products that are not restricted by existing regulations, particularly for high-value innovative drugs [3][5]. Group 2: Market Growth and Challenges - The commercial health insurance market is projected to reach CNY 997.3 billion by 2025, indicating a significant growth opportunity as it approaches the CNY 1 trillion threshold [4]. - The industry faces challenges such as rising product prices and increased claims, which have led to a mismatch between supply and demand in the critical illness insurance segment [4][5]. Group 3: Inclusion of Diverse Insured Groups - The measures advocate for relaxing underwriting conditions to include elderly individuals and those with chronic diseases, thereby expanding the potential insured population [5][6]. - The policy also proposes using personal medical account funds for purchasing eligible commercial health insurance products, creating a substantial funding pool for the market [5][6]. Group 4: Service Optimization and Industry Transformation - The measures call for the optimization of service experiences, including online insurance applications and claims processing, as well as collaboration with rehabilitation and nursing institutions [6][8]. - The industry is encouraged to transition from traditional fee-for-service models to value-based insurance products that integrate health management and proactive risk control [8]. Group 5: Strategic Role of Commercial Health Insurance - The measures position commercial health insurance as a proactive partner in the healthcare ecosystem, responding to the need for a multi-tiered medical security system and supporting pharmaceutical innovation [7][8]. - The industry is entering a "3.0 era," characterized by balanced product structures and a shift towards personalized insurance solutions driven by data analysis and risk management [7][8].