Core Viewpoint - The collaboration between basic medical insurance and commercial health insurance in China is advancing significantly, with new measures and systems being implemented to enhance efficiency and accessibility for patients [1][2][3][4]. Group 1: Policy Developments - The first national "medical insurance + commercial insurance" clearing settlement center has begun operations in Beijing, reducing the time lag in claims settlement between the two systems [1]. - A joint initiative by the Shanghai Financial Regulatory Bureau and seven other departments has been launched to promote the high-quality development of commercial health insurance, focusing on payment mechanisms and data sharing [1][2]. - The preliminary review of the innovative drug directory for commercial insurance, which includes several high-priced cancer drugs, has been completed, providing new payment avenues for innovative drugs [1][2]. Group 2: Market Insights - As of 2024, the basic medical insurance system covers 1.326 billion people, maintaining a coverage rate of 95%, with total fund expenditures reaching 2.97 trillion yuan [2]. - The commercial health insurance market is experiencing rapid growth, with original insurance premium income reaching 977.3 billion yuan in 2024, a year-on-year increase of 8.2% [2]. - Despite the growth, there remains significant room for improvement in the coverage and effectiveness of commercial health insurance compared to the over 95% utilization rate of basic medical insurance funds [2]. Group 3: Operational Enhancements - The new clearing settlement center allows patients to complete basic insurance reimbursement and directly use commercial insurance for remaining costs, streamlining the payment process [2][3]. - The National Medical Insurance Administration is exploring synchronized settlement between basic and commercial health insurance, aiming to reduce patient burden through data sharing [3]. - Future developments will include collaborative efforts to expand the coverage of commercial health insurance and enhance the integration of data and regulatory frameworks between the two systems [4].

Core Viewpoint - The collaboration between basic medical insurance and commercial health insurance in China is advancing significantly, with new measures and systems being implemented to enhance efficiency and accessibility for patients [1][2][3][4]. Group 1: Policy Developments - The first national "medical insurance + commercial insurance" clearing settlement center has begun operations in Beijing, reducing the time lag in claims settlement between the two systems [1]. - A joint initiative by the Shanghai Financial Regulatory Bureau and seven other departments has been launched to promote the high-quality development of commercial health insurance, focusing on payment mechanisms and data sharing [1][2]. - The initial review of a new commercial insurance innovative drug directory has been completed, featuring several high-priced cancer drugs, providing new payment avenues for innovative medications [1][2]. Group 2: Market Statistics - As of 2024, the number of participants in basic medical insurance is 1.326 billion, maintaining a coverage rate of 95%, with total fund expenditures reaching 2.97 trillion yuan [2]. - The commercial health insurance market is experiencing rapid growth, with original insurance premium income reaching 977.3 billion yuan in 2024, a year-on-year increase of 8.2% [2]. Group 3: Operational Improvements - The new clearing settlement center allows patients to use their medical insurance code for basic reimbursement and then directly use their commercial insurance code for remaining payments, streamlining the reimbursement process [2]. - The National Medical Insurance Administration is exploring synchronized settlement between basic medical insurance and commercial health insurance, aiming to reduce patient burden through data sharing [3]. Group 4: Future Directions - The collaboration between basic medical insurance and commercial health insurance is expected to enhance drug accessibility, foster innovation in the pharmaceutical industry, and support the development of commercial health insurance [4]. - There are plans to explore the coordination of coverage areas, allowing commercial health insurance to complement basic medical insurance, particularly through the establishment of an innovative drug directory [4]. - The industry is transitioning from a single-track payment system to a multi-channel payment mechanism, although challenges remain in establishing payment access mechanisms for innovative drugs and developing pricing systems for insurance and pharmaceuticals [4].

Core Viewpoint - The era of collaborative development between medical insurance and commercial insurance has arrived, as evidenced by recent policy changes and initiatives aimed at enhancing the synergy between commercial health insurance and the biopharmaceutical industry [1][2]. Group 1: Policy Initiatives - In July 2023, Shanghai introduced 28 measures to support the development of innovative drugs and medical devices, which has sparked industry discussions and set a precedent for nationwide implementation [1]. - Recently, seven departments in Shanghai released 18 specific measures to promote the high-quality development of commercial health insurance, focusing on payment mechanisms, data sharing, service models, and regulatory innovation [1][4]. - The 18 measures represent a systematic approach to creating a dual empowerment mechanism between commercial health insurance and biopharmaceutical innovation, emphasizing the need for diverse payment mechanisms beyond basic medical insurance [1][4]. Group 2: Highlights of Commercial Health Insurance Innovation - One highlight is the support for "pre-existing condition" insurance, allowing the trial development of insurance products for patients with chronic diseases under a regulatory sandbox mechanism [3]. - The measures also aim to activate individual medical account funds, permitting eligible group health insurance to use accumulated personal account balances for payments [3]. - There is encouragement for "insurance + service" models, promoting the development of long-term care insurance and collaboration between insurance companies and health service providers [3]. Group 3: Focus on Group Health Insurance - The 18 measures will prioritize the development of group health insurance, which has proven to be a mature sector, particularly in providing customized corporate supplementary medical insurance [3][4]. - Group health insurance can effectively cover pre-existing conditions and chronic diseases, addressing adverse selection issues while expanding funding and improving management efficiency [3]. - The measures will also focus on innovative drugs and medical devices, encouraging the insurance industry to develop exemplary clauses for group health insurance that include new medical technologies and products [4]. Group 4: Future Outlook for Consumers - The future of insurance products is expected to be more diverse, with broader coverage and more efficient services, reducing the economic burden of using innovative drugs and medical devices for consumers [5]. - Shanghai plans to optimize existing insurance products and develop specialized offerings for specific demographics, such as the elderly and those with pre-existing conditions [5]. - The implementation of policies will continue to signal positive developments in the market, with efforts to eliminate payment bottlenecks for innovative drug applications and support the growth of the biopharmaceutical industry [5].

Core Viewpoint - The National Healthcare Security Administration (NHSA) is promoting collaboration between basic medical insurance and commercial health insurance to address challenges faced by the latter, focusing on areas such as coverage, data, settlement, and regulation [1] Group 1: Coverage Collaboration - The NHSA aims to explore the support of commercial health insurance in conjunction with basic medical insurance, establishing a clear boundary for basic medical insurance coverage to allow room for the development of commercial health insurance [1] - The initiative includes the establishment of an innovative drug directory for commercial insurance as a starting point [1] Group 2: Data Collaboration - The NHSA emphasizes the importance of data collaboration, ensuring data security and privacy while promoting the application of medical insurance data in the commercial health insurance sector [1] - This collaboration aims to facilitate rapid underwriting and claims processing for commercial health insurance products [1] Group 3: Settlement Collaboration - The NHSA is exploring synchronized settlement processes between basic medical insurance and commercial health insurance, enabling patients to achieve simultaneous settlement at medical institutions when purchasing relevant commercial insurance [1] Group 4: Regulatory Collaboration - The NHSA plans to share its intelligent regulatory platform and capabilities to gradually achieve coordinated regulation between basic medical insurance and commercial health insurance [1] - This effort aims to ensure the reasonable use of funds in commercial health insurance and maintain its stable operation [1]