Core Points - Shanghai has introduced measures to promote the high-quality development of commercial health insurance, aimed at supporting innovation in the biopharmaceutical industry and enhancing public health insurance services [1] - The measures include 5 areas and 18 specific actions to improve the accessibility and affordability of innovative drugs and medical devices, addressing the diverse health protection needs of citizens [1] Summary by Categories Policy Measures - The measures focus on deepening the payment mechanism for innovative drugs and medical devices, facilitating their entry into hospitals, directories, and prescriptions [1] - Cases involving innovative drugs within the scope of commercial health insurance will not be included in the disease-based payment range, encouraging insurance companies to use clinical trial data for pricing [1] Technological Integration - Shanghai will enhance the functionality of the "Shanghai Insurance Code" to optimize the synchronous settlement model between public health insurance and commercial insurance [1] - The initiative aims to improve direct compensation service processes and establish an active compensation system that integrates medical, health insurance, and commercial insurance data [1] Impact on Health Insurance - The introduction of these measures is expected to further establish commercial health insurance as a crucial pillar of the public health protection system, providing citizens with more comprehensive, diverse, and convenient health coverage [1]

Group 1 - The Shanghai Financial Regulatory Bureau, in collaboration with various departments, has issued measures to promote the high-quality development of commercial health insurance to support innovation in the biopharmaceutical industry, outlining 18 specific work measures across five areas [1][2] - Shanghai aims to expand the coverage of commercial health insurance, diversify product offerings, and accelerate the development of commercial nursing insurance to establish a multi-tiered commercial health insurance product system [1] - The measures encourage the development of health insurance products tailored to specific groups such as the elderly, children, and those with chronic conditions, while also supporting insurance companies in enhancing health management services [1][2] Group 2 - The initiative includes plans to deepen the interconnectivity of medical, health insurance, and commercial insurance data, using clinical trial data and disease adaptation as pricing references for insurance companies [2] - Shanghai will innovate payment mechanisms for innovative drugs and medical devices, facilitating their integration into hospitals and insurance coverage, while ensuring that cases involving these innovations are not included in the disease-based payment scope [2] - The measures are expected to stimulate the commercial health insurance market, positioning it as a crucial pillar in the health protection system and a key participant in the multi-faceted payment system for new and superior drugs and devices [2]

Group 1 - The core viewpoint of the news is the introduction of measures by the Shanghai Financial Regulatory Bureau to promote the high-quality development of commercial health insurance, enhancing the insurance industry's ability to serve public health needs and improving the accessibility and affordability of innovative drugs and medical devices [1][2] - The measures include five main areas with 18 specific actions aimed at broadening the coverage of commercial health insurance and developing a multi-tiered product system [1] - There is a focus on developing health insurance products tailored for specific groups such as the elderly, children, and those with chronic illnesses, as well as enhancing health management services to reduce risks [1][2] Group 2 - The measures encourage the development of group health insurance products that involve employer contributions and cover innovative drug costs, aiming to establish a risk adjustment mechanism in key economic sectors [1][2] - There is an emphasis on deepening the interconnectivity of medical, health insurance, and commercial insurance data, using clinical trial data as pricing references for insurance companies [2] - The introduction of innovative payment mechanisms for new drugs and medical devices is supported, facilitating their integration into hospitals and insurance coverage, while also promoting tax deductions and funding optimization for commercial health insurance [2]

Group 1 - The core viewpoint of the news is the introduction of measures by the Shanghai Financial Regulatory Bureau to promote the high-quality development of commercial health insurance, enhancing the insurance industry's ability to serve public health needs and improving the accessibility and affordability of innovative drugs and medical devices [1][2] - The measures include five main areas with 18 specific actions aimed at broadening the coverage of commercial health insurance and enriching product forms, particularly focusing on developing commercial nursing insurance and a multi-tiered product system [1] - There is an emphasis on encouraging the development of health insurance products tailored for specific groups such as the elderly and those with chronic conditions, as well as enhancing health management services to reduce risks [1][2] Group 2 - The measures advocate for the creation of group health insurance products that involve employer contributions, covering innovative drug and device costs, and aligning with basic medical insurance for seamless settlement [1][2] - There is a push for deepening the interconnectivity of medical, health insurance, and commercial insurance data, using clinical trial data as pricing references for insurance companies, and supporting a "one-stop" settlement service [2] - The introduction of innovative payment mechanisms for new drugs and devices is encouraged, facilitating their integration into hospitals and insurance coverage, while also promoting tax deductions and optimized funding to support the growth of commercial health insurance [2]

Core Viewpoint - The Shanghai Financial Regulatory Bureau, in collaboration with various governmental departments, has issued measures to promote the high-quality development of commercial health insurance, aiming to support innovation in the biopharmaceutical industry [1][4]. Group 1: Measures Overview - The measures consist of five main areas and eighteen specific actions, including the construction of a multi-tiered commercial health insurance product system and the enhancement of service capabilities [1]. - There is a focus on expanding the coverage of commercial health insurance products, particularly in nursing insurance, and integrating innovative drugs and medical devices into the coverage [1][4]. Group 2: Targeted Populations - The measures encourage the development of health insurance products tailored to specific groups, such as the elderly and those with pre-existing conditions, to enhance insurance coverage for these populations [2]. - Collaboration between insurance institutions and the health industry is emphasized to improve the accessibility and affordability of innovative drugs [2]. Group 3: Service Optimization - The measures propose strengthening the health service capabilities of insurance institutions and expanding services from post-claim to proactive health management [2]. - Encouragement is given for partnerships between insurance companies and healthcare providers to enhance preventive care and chronic disease management [2]. Group 4: Innovation and Data Sharing - The measures advocate for the establishment of a "regulatory sandbox" to pilot innovative health insurance products, ensuring compliance and sustainability [3]. - There is a call for improved data sharing mechanisms among medical, insurance, and pharmaceutical sectors to support product design and risk assessment [3]. Group 5: Payment Mechanisms - The measures suggest innovating payment mechanisms for innovative drugs, involving multiple stakeholders such as insurance, charity organizations, and pharmaceutical companies [4]. - The goal is to facilitate the clinical application of innovative drugs and ensure they are included in insurance coverage without affecting basic medical insurance metrics [4].