商业健康保险高质量发展

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上海:鼓励保险机构与医疗机构、体检机构等开展合作
Bei Jing Shang Bao· 2025-08-06 11:59
《若干措施》提到,优化商业健康保险服务方式。加强保险机构健康服务能力建设,探索制定健康管理 服务、技术、数据等相关标准,从事后理赔扩展至事中事前增值服务,提供一揽子健康管理综合服务。 鼓励保险机构与医疗机构、体检机构、康复护理机构、签约家庭医生等开展合作,在预防健身、健康检 查、疾病康复、慢病管理等各类场景,形成与消费者良性互动,发挥保险健康管理的风险减量作用。 北京商报讯(记者 李秀梅)8月6日,国家金融监督管理总局上海监管局、上海市医疗保障局、上海市 委金融委员会办公室、上海市发展和改革委员会、上海市科学技术委员会、上海市卫生健康委员会、上 海市浦东新区人民政府印发《关于促进商业健康保险高质量发展助力生物医药产业创新的若干措施》 (以下简称《若干措施》)。 ...
上海:延伸商业健康保险服务领域,提升创新药械的可及性和可负担性
Bei Jing Shang Bao· 2025-08-06 11:59
Core Viewpoint - The document outlines measures to promote the high-quality development of commercial health insurance, aiming to support innovation in the biopharmaceutical industry through enhanced collaboration and service extension [1] Group 1: Measures for Commercial Health Insurance - The measures emphasize extending the service areas of commercial health insurance [1] - There is a focus on promoting the synergy between commercial health insurance, medical services, medical insurance, and pharmaceuticals [1] - The initiative encourages collaboration between insurance institutions and entities in the health industry and biopharmaceutical sector [1] Group 2: Collaboration and Innovation - The document highlights the importance of leveraging the professional advantages of medical expense audits to participate in standardizing medical practices [1] - It explores mechanisms for collective procurement price negotiations for drugs, communication regarding new drug listings, and payment based on treatment efficacy [1] - The goal is to enhance the accessibility and affordability of innovative drugs and medical devices [1]
上海:将医疗新技术、新药品、新器械等纳入商业健康保险保障范围
Bei Jing Shang Bao· 2025-08-06 11:08
北京商报讯(记者 李秀梅)8月6日,国家金融监督管理总局上海监管局、上海市医疗保障局、上海市 委金融委员会办公室、上海市发展和改革委员会、上海市科学技术委员会、上海市卫生健康委员会、上 海市浦东新区人民政府印发《关于促进商业健康保险高质量发展助力生物医药产业创新的若干措施》 (以下简称《若干措施》)。 《若干措施》提到,拓宽商业健康保险保障内容。鼓励保险机构坚持商业健康保险保障属性,适应消费 者需求,提供包括医疗、疾病、康复、照护等多领域的健康保险产品和服务。完善保障内容,将供需适 配的医疗新技术、新药品、新器械、新耗材应用纳入保障范围,发展多层次的商业健康保险产品和服 务。 ...
【财经分析】惠民保迈入发展新阶段 参保率续保率是关键
Xin Hua Cai Jing· 2025-06-27 06:42
Core Insights - The introduction and promotion of "Hui Min Bao" effectively strengthen the connection between commercial insurance and basic medical insurance, becoming an important exploration in improving China's multi-tiered medical security system [1][2]. Group 1: Development and Impact - "Hui Min Bao" is a government-guided, inclusive commercial health insurance aimed at providing supplementary medical coverage for basic medical insurance participants, significantly alleviating the issue of poverty caused by illness [2]. - Since its launch in 2020, "Hui Min Bao" has rapidly expanded across the country, becoming a crucial part of China's multi-tiered medical security system, with over 168 million participants by 2023 [2][4]. - The average growth rate of total participants in "Hui Min Bao" has slowed, with a 6% year-on-year increase in 2023, indicating a shift from explosive growth to stable development [4]. Group 2: Challenges and Opportunities - Despite rapid development, "Hui Min Bao" faces challenges such as regional disparities in participation rates, product homogeneity, and inefficiencies in claims services [3][5]. - The average participation rate of 53 analyzed products is 18.9%, showing a downward trend, while some products, like "Zhe Li Bao," have achieved a participation rate of 91.34% [6]. - The health insurance sector is experiencing favorable opportunities due to increased policy support and rising healthcare costs, with total health expenditure in 2023 reaching 7.2% of GDP [2][6]. Group 3: Future Directions - Experts suggest that "Hui Min Bao" should focus on sustainability, precise coverage, and digital services to better meet the diverse health security needs of the population [6][7]. - There is a call for the development of specialized products targeting specific demographics, such as migrant workers and the elderly, to address the issue of product homogeneity [6][7]. - The future of "Hui Min Bao" is expected to transition from "incremental expansion" to "high-quality development," with an emphasis on policy support and technological innovation [7][8].