商业医疗险报告三：探索受益于商业医疗险发展的细分赛道

Investment Rating - The report maintains an "Outperform" rating for the biopharmaceutical industry [1] Core Viewpoints - The development of commercial health insurance is supported by favorable policies, with significant potential for capital inflow. Since 2009, policies have continuously supported the establishment of a multi-level medical security system and the development of commercial health insurance. The sharing of medical insurance data with commercial insurance companies is entering a practical phase, which is expected to improve the insurance landscape [2][28] - The commercial health insurance sector is projected to reach a compensation scale of approximately 471.57 billion yuan by 2030 under neutral expectations, indicating substantial potential for the medical industry [31][32] Summary by Sections Part 1: Commercial Health Insurance is Flourishing, Compensation Growth is Expected - The demand side emphasizes the impact of premium pricing and the insurance needs of patients with pre-existing conditions and the elderly. The increase in disposable income and policies allowing the use of personal medical insurance accounts for purchasing health insurance are expected to enhance insurance uptake [11][12][29] - The supply side highlights the importance of product design in health management, special drug coverage, and deductible settings. Enhancements in these areas can attract more policyholders and improve profitability [20][21][28] Part 2: Current Situation: Insufficient Motivation for Innovative Drug and Device Use - The DRG payment system has reduced the motivation for hospitals to use innovative drugs and devices, necessitating the exploration of alternative payment sources. High-level hospitals face greater pressure under the DRG system, which may hinder the adoption of innovative treatments [35][39] Part 3: Commercial Insurance Development Benefits Innovative Drugs and DTP Pharmacies - The commercial health insurance sector is increasingly covering innovative drugs, with payments rising from 1.1 billion yuan in 2020 to 2.2 billion yuan in 2023, reflecting a compound annual growth rate of 27.8%. The penetration rate for commercial health insurance in the innovative drug market remains low, indicating significant room for growth [67][68] - DTP pharmacies are emerging as a crucial channel for the distribution of innovative drugs, providing a pathway for patients to access high-value medications outside of traditional hospital settings [76][80] Part 4: Innovative Devices May Benefit from Commercial Insurance Development - Innovative medical devices, particularly those not fully covered by insurance, are expected to benefit from commercial insurance. The report suggests that high-value medical devices and certain surgical procedures may gain traction in the commercial insurance market [4][81] Part 5: Investment Recommendations - The report recommends focusing on companies with rich pipelines in innovative drugs, such as Heng Rui Medicine and BeiGene, as well as DTP pharmacies and TPA (Third Party Administrator) companies that are well-positioned to benefit from the growth of commercial health insurance [4][81]