体检预防+创新药械保障
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引入健康体检管理,能否改变创新药支付与惠民保融合困境?
Di Yi Cai Jing· 2025-11-21 01:45
Core Insights - The transition of Huiminbao from "post-compensation" to "prevention" is highlighted, indicating a shift in focus towards proactive health management and risk reduction in the insurance sector [1][4] Group 1: Market Dynamics - The payment paradox between insurance companies and pharmaceutical firms is discussed, where insurers aim to cover healthy individuals to control costs, while drug companies focus on medication usage for market value [1] - The expected market size for innovative drug sales in 2024 is projected to reach 162 billion yuan, with commercial health insurance expenditures estimated at 12.4 billion yuan, contributing only 7.7% [1] - Huiminbao's share in the compensation for innovative drugs is 15%, which is lower than disease insurance and million medical insurance, accounting for 47% and 22% respectively [1] Group 2: Product Development and Challenges - The proportion of normally operating Huiminbao products decreased from 74.3% in 2023 to 66.68% in 2024, indicating ongoing challenges in market performance [3] - The decline in Huiminbao product numbers is attributed to lower-than-expected participation rates and difficulties in expanding the risk pool [3] - New product offerings are being introduced, such as health check management services, to enhance participant engagement and address operational pressures [3] Group 3: Health Management Integration - The integration of health management into commercial health products is emphasized as a means to reduce the risk of major diseases through early detection and intervention [4] - The model of "health management + Huiminbao" aims to shift the focus from post-event compensation to preemptive measures, enriching risk management strategies [4] - The combination of preventive health checks and innovative drug coverage is seen as a significant advancement in insurance, potentially lowering the disease burden on the population [4] Group 4: Industry Trends - The rise of health management services in insurance has been noted since 2016, although growth remains slow due to a lack of experience in managing medical models [5] - The potential of commercial health insurance in the innovative drug payment sector is yet to be fully realized, with ongoing exploration needed for deeper integration of technology, payment, and value [5]