【粤开医药】优化商业健康保险对创新药的支付——医保数据共享是关键

Investment Rating - The report does not explicitly state an investment rating for the industry Core Insights - The commercial health insurance sector in China has rapidly expanded, with premium income increasing from 112.35 billion yuan in 2013 to 903.45 billion yuan in 2023, reflecting an average annual growth rate of 23.2% over the past decade. However, its contribution to overall healthcare spending remains low, accounting for only about 4% of the total medical expenditure of 85,327.5 billion yuan in 2022 [7][27][26] - The penetration of commercial health insurance in the innovative drug payment sector is still limited, with only 5.3% of the 1,400 billion yuan market for innovative drugs covered by commercial health insurance in 2023, amounting to approximately 7.4 billion yuan [27][26] - The report emphasizes the need for optimizing commercial health insurance payments for innovative drugs through the sharing of medical insurance data, which could address issues such as low payment volumes, limited product variety, and sustainability concerns [12][40] Summary by Sections Current Support and Issues of Commercial Health Insurance for Innovative Drugs - The scale of commercial health insurance has grown significantly, but its share of overall healthcare costs and innovative drug expenditures remains low. In 2022, commercial health insurance payouts were only 3,599.5 billion yuan, compared to 24,597.24 billion yuan for basic medical insurance [7][26] - The payment for innovative drugs through commercial health insurance is primarily concentrated in group insurance, critical illness insurance, and local supplementary insurance, with most products only covering out-of-pocket expenses for drugs listed in the medical insurance directory [27][32] Optimization of Payments for Innovative Drugs - The report highlights the importance of data sharing from medical insurance platforms to enhance the payment capabilities of commercial health insurance for innovative drugs. This includes historical data analysis and sharing information on drugs, medical supplies, and service projects [12][44][40] Market Performance - The pharmaceutical and biotechnology index rose by 2.15% in November, outperforming the CSI 300 index by 1.49 percentage points. However, the index has declined by 9.29% year-to-date, lagging behind the CSI 300 index by 23.43 percentage points [47][49] - The total trading volume in the pharmaceutical and biotechnology sector reached 21,798.51 billion yuan in November, accounting for 5.28% of the total A-share market, indicating a relatively high trading activity [52] Industry News - The report discusses the pilot program for expanding foreign-invested hospitals, which is expected to enhance the supply of high-end medical services and benefit the commercial health insurance and innovative drug sectors. The policy allows foreign-invested hospitals to become designated medical insurance institutions, potentially increasing the market for commercial health insurance [60][61]