Workflow
医保商保双支柱支付体系
icon
Search documents
商业保险助力提升创新药械可及性
Jing Ji Ri Bao· 2025-08-17 21:55
Core Viewpoint - The article emphasizes the accelerating role of commercial health insurance in the payment for innovative drugs and medical devices, driven by recent policy measures aimed at enhancing the multi-tiered medical security system in China [1][4]. Group 1: Policy Developments - The National Healthcare Security Administration and the National Health Commission have issued measures to support the high-quality development of innovative drugs, including the establishment of a "commercial health insurance innovative drug directory" [1]. - Local governments, such as Shanghai and Chengdu, have introduced supportive policies to facilitate the integration of innovative drugs into insurance coverage, addressing the affordability and accessibility of these treatments [1][2]. Group 2: Market Insights - The innovative drug and medical device market in China is projected to reach approximately 1.62 trillion yuan (about 1620 billion yuan) in 2024, with commercial health insurance contributing only 124 billion yuan (7.7% of the total) [1]. - If the share of commercial health insurance payments increases to 44% by 2035, the market size could reach 440 billion yuan, significantly alleviating the financial burden on patients [2]. Group 3: Challenges and Recommendations - Despite policy incentives, commercial health insurance faces challenges such as inadequate data sharing and payment integration with basic medical insurance, which hampers product design and scalability [3]. - Recommendations to enhance commercial health insurance's support for innovative drugs include improving funding efficiency, optimizing product design, establishing a unified drug directory, and leveraging technology to enhance payment and management efficiency [3]. Group 4: Future Outlook - The gradual implementation of policies is expected to allow commercial health insurance to play a larger role in the payment system, fostering a complementary and collaborative relationship with basic medical insurance [4]. - The development of a multi-channel payment mechanism for innovative drugs is crucial for both patient welfare and the health of the pharmaceutical industry [4].