镁信健康张小栋：医险融合需要搭建“新基建”｜未来保障谈

Core Viewpoint - The article emphasizes the transformation of commercial health insurance from merely a "payment tool" to a "value engine" that integrates deeply into the pharmaceutical innovation ecosystem, facilitating a win-win situation for patients, sustainable medical insurance funds, and biopharmaceutical innovation [1][4]. Group 1: Industry Context - China's healthcare reform is entering a critical phase, focusing on "value-based healthcare," which is redefining the boundaries of "coverage" and positioning commercial health insurance as a key player in a multi-tiered medical security system [3][4]. - The commercial health insurance sector is expected to play a crucial role as a "supplement" to basic medical insurance and as an "integrator" of medical resources, while also exploring innovative payment and health management models [3][4]. Group 2: Market Dynamics - In 2024, the market size for innovative drugs in China is projected to reach 162 billion yuan, with a year-on-year growth of 16%. Personal cash payments are expected to account for approximately 49% of this, while commercial health insurance expenditures are only about 7.7% [5]. - The integration of commercial health insurance with the healthcare industry is deepening, with companies like Mingxin Health acting as connectors to provide diverse payment solutions [5][6]. Group 3: Company Initiatives - Mingxin Health, founded in 2017, aims to bridge the gap between patients, pharmaceutical companies, and insurance providers, making high-quality medications more accessible [5][8]. - The company has developed various innovative products, including financial installment plans for expensive cancer treatments and specialized insurance for innovative drugs, which have become standard offerings in medical insurance [8][9]. Group 4: Challenges and Opportunities - The current commercial health insurance landscape faces challenges such as inadequate coverage for high-value innovative drugs, limited service levels, and insufficient penetration among target populations [13][14]. - To address these challenges, the industry must enhance its core capabilities, focusing on high-quality medical service provision, comprehensive coverage of advanced drugs, and improved technological payment and risk control capabilities [14][15]. Group 5: Innovative Payment Solutions - Mingxin Health has introduced the "One Code Direct Payment" system, allowing users to settle medical expenses without upfront payments, thereby alleviating financial pressure on patients [15][16]. - This system aims to streamline the claims process and enhance user experience, reflecting a broader shift in consumer demand from mere medical services to comprehensive health management and preventive care [16].