从医保业务"全城通办"打破地域限制，到"15分钟医保服务圈"织密便民网络，一项项务实举措落地生根， 从数字赋能让"数据多跑路"，到民生兜底让"温暖广覆盖"，一项项务实举措落地生根，广州医保改革让政策红 利化作群众触手可及的获得感、实打实的幸福感。 "现在办医保，不管在哪个区，找个窗口都能办，材料、流程都一样，真是太方便了！"谈及医保服务全市 通办的便利，在白云区工作、番禺区居住的陈先生连连称赞。 早在2015年，广州医保便率先搭建起标准化服务体系，通过敲定120项业务工作标准，将所有服务事项纳 入清单化管理范畴，全面推行"全城通办+综合柜员制"服务模式。 如今，群众走进广州11个区的任一医保窗口，都能享受到无差别的"一窗综合受理、一次办结"服务。 针对群众办事"看不懂、跑多次"的痛点，广州医保进一步优化服务细节，梳理优化220个短信模板、26个 业务样表，推出"一事一指引"指南与业务解读视频，用"大白话"拆解办事流程，让指引听得懂、用得上。 数字赋能："数据多跑路"换"群众少跑腿"的智能升级 "怀孕后了解生育政策，打开广州医保AI就能问，不仅有详细解答，还直接推送业务流程和办事入口。"职 工医保参保人王女士深 ...

兰及五号 目間最高劃/ 保险工 2025 年 10 月 10 日 版 发行业 相关研究 若研究祝 证券分析师 罗钻辉 A0230523090004 luozh@swsresearch.com 孙冀齐 A0230523110001 sunjq@swsresearch.com 联系人 请务必仔细阅读正文之后的各项信息披露与声明 孙冀齐 (8621)23297818× sunjg@swsresearch.com 申万宏源研究微信服务号 看好健康险的二次腾飞机遇 ――《关于推动健康保险高质量发展的指导意见》点评 新"国十条"在健康险领域迎来专项落实。9 月 30 日，金管局发布《关于推动健康保险高质 量发展的指导意见》(简称"《意见》")，标志着新"国十条" 在健康保险领域的专项落实，外 部环境、客户需求变化叠加政策支持态势下，看好低利率时代健康险产品的二次腾飞机遇。 明确健康险的四大分类,进一步完善多元化健康保障及服务体系。1) 明确健康保险的产品分 类、政策定位及发展方向:i) 商业医疗保险:政策定位为"积极发展",需构建"全覆盖、多 层次"的产品体系，扩大保障范围，提升保险费率与承保风险的匹配度；ii) 商业长 ...

引言： 医药行业，始终是一条充满韧性又孕育惊喜的黄金赛道。它既承载着人类对健康最本真的渴望，又汇集 了科技突破与政策变革的时代浪潮。回顾过往十五年，医药板块历经多轮牛熊转换，每一次低谷都在为 下一次爆发蓄力，而每一次崛起，都伴随着产业结构的深刻变革。 当前，随着中国创新药在国际舞台频频"破圈"，政策利好层层释放，人口老龄化带来需求长周期扩张， 医药行业正再次站在时代的聚光灯下。 ●复盘十五年行情：医药板块的周期轮动与涨跌逻辑 医药行业从来都不缺故事，更不缺行情。回顾过去十五年，医药行业经历了多次显著的市场周期，每一 轮牛市都有其独特的驱动因素与市场表现。 ※2009-2010年，"四万亿"政策推动市场反弹，叠加医药行业整改完成、医保目录扩容与支出扩张，行 业上市公司业绩大增，中证申万医药生物指数飙涨148.46%，远超同期上证指数涨幅54.22%，成为当时 市场中的"领涨先锋"（数据来源：Wind，统计区间：2009.1.1-2010.12.31。中证申万医药生物指数代 码：000808.CSI，基日：2004-12-31，发布日期：2012-02-17，成份数量：100，发布机构：中证指数有 限公司；上证指 ...

文章来源：http://www.beijingxueche.com.cn 2025年的医保改革可以看作是一枚硬币的两面：它既带来了更广泛的报销范围和就医便利，也对个人的医疗消费习惯提出了新要求。下面这个表格可以帮助 你快速抓住这次改革的核心变化和对你生活的可能影响。 改革领域主要变化对你的潜在影响 账户结构与门诊报销个人账户资金减少，普通门诊费用纳入统筹报销。日常看小病的即时负担减轻，但个人账户可自由 支配的钱变少。长期看，频繁就医者可能受益，健康人群直观感受是账户进账减少。 报销范围与目录药品目录扩容（新增287种药），慢性病用药保障加 强，但部分药品和耗材需自费。大病、慢性病用药负担显著降低。但一些非治疗性药品、特殊材质耗材等可能需要自己承担更多费用。 就医便利与流程检 查结果互认、取消门诊预交金、异地就医结算普及、电子凭证推广。减少重复检查和排队垫资的麻烦，跨区域看病更方便，整体就医体验更顺畅。⚖️ 参保 激励与约束连续参保和基金零报销可提高大病保险支付限额；中断参保将面临待遇等待期。强化长期连续参保的导向，中断缴费的成本更高，稳定参保的重 要性凸显。 如何应对新变化 面对这些调整，你可以通过一些积极的 ...

Core Viewpoint - The article discusses the challenges and potential solutions in China's healthcare insurance reform, particularly focusing on the imbalance in personal account funds between different age groups and the need for strategic investment to address a significant funding gap in the system [1][10]. Group 1: Structural Issues in Personal Accounts - By 2025, the contribution standard for employee health insurance personal accounts has decreased by 28% compared to historical peaks, with those under 35 seeing their contribution rate reduced to 2% [4]. - The aging population is leading to a significant disparity, with retirees having a hospitalization rate nearly four times that of currently employed individuals, while those over 80 have an average personal account balance of less than 200 yuan [4]. - In some developed regions, individual health insurance accounts have accumulated balances exceeding 120,000 yuan, exacerbating the intergenerational financial burden on the healthcare system [4]. Group 2: Investment Strategies and Fund Management - As of March 2025, the entrusted investment scale of the basic pension insurance fund has surpassed 2.4 trillion yuan, marking a 20% increase from the previous year [7]. - The investment strategy is shifting towards a higher allocation in equity assets, aiming to reach a policy limit of 15%, which could potentially generate an additional 180 billion yuan in annual investment returns based on historical market performance [7]. - Innovative mechanisms for regional balance, such as directing 30% of investment returns to cover current fund deficits, have already resulted in increased monthly benefits for retirees in certain provinces [7]. Group 3: Technological Enhancements in Oversight - The use of blockchain technology for real-time monitoring of investment projects has been implemented, covering 92% of investment activities and enabling rapid tracking of fund flows [8]. - A smart risk control system developed by a major state-owned bank successfully intercepted 23 potential abnormal transactions within three months, preventing over 800 million yuan in potential losses [8]. Group 4: Challenges and Future Trends - There exists a cognitive gap among younger insured individuals regarding the "family mutual aid" mechanism, with 43% believing that personal account funds are private property, which poses a challenge for reform implementation [9]. - The introduction of a dynamic adjustment mechanism for fund allocation will link the distribution of healthcare accounts to key indicators like aging rates, enhancing the system's adaptability [14]. - Future trends indicate a rise in service penetration rates, with community service stations expected to exceed 65%, and AI investment advisors managing over 40% of pension fund assets for personalized risk-reward matching [12].

Core Viewpoint - The article emphasizes that the integration of the "three medical" systems and the downward flow of quality resources are key to addressing the weak capacity of grassroots medical services in China. The government plans to enhance medical insurance reimbursement for grassroots institutions and improve the linkage mechanism for medication between different levels of healthcare facilities [3][4]. Summary by Sections Implementation Plan Overview - The State Council has officially released the "Implementation Plan for Strengthening Basic Medical and Health Services," which aims to enhance the capacity of grassroots medical services during the 14th Five-Year Plan period. The plan is a crucial part of building a healthy China and promoting comprehensive rural revitalization [3][4]. Goals and Objectives - By 2027, the plan aims for a more rational layout of grassroots medical institutions, with a target for residents to reach the nearest medical service point within 15 minutes. By 2030, the service volume of county-level and below medical institutions is expected to increase significantly, and the construction of a hierarchical diagnosis and treatment system will show notable results [4]. Key Tasks - The plan outlines 12 key tasks focusing on system improvement, service optimization, strengthening disease control, and enhancing resource support. Specific targets include achieving a 70% management rate for hypertension and type 2 diabetes patients at the grassroots level by 2030 [4][5]. Financial and Resource Allocation - The plan encourages the participation of social medical institutions in government-purchased basic public health services. It sets quantitative indicators for improving grassroots diagnostic capabilities, such as ensuring that counties with a population of over 50,000 can perform cataract surgeries and dialysis by 2030 [5][6]. Incentives and Reforms - To enhance grassroots medical capabilities, the plan proposes various reforms, including adjusting medical service prices, reforming medical insurance payment methods, and establishing a dynamic adjustment mechanism for staffing. It aims to create a robust incentive mechanism for grassroots development [6][7]. Fiscal Support - The plan highlights the need for increased fiscal investment, ensuring that the government fulfills its financial responsibilities for public health institutions and basic public health services, with a focus on increasing funding for grassroots medical institutions [8].

Core Viewpoint - The company reported a significant decline in revenue and net profit for the first half of 2025, with expectations of a market turnaround in the domestic sector and continued growth in international markets [1][2][3]. Financial Performance - In the first half of 2025, the company achieved operating revenue of 16.743 billion yuan, a year-on-year decrease of 18.45% - The net profit attributable to shareholders was 5.069 billion yuan, down 32.96% - The second quarter saw operating revenue of 8.506 billion yuan, a decline of 23.77%, and net profit of 2.440 billion yuan, down 44.55% [1]. Market Trends - Domestic market conditions are expected to improve in the third quarter of 2025, following a significant drop in medical equipment bidding data since December 2024, which affected revenue recognition cycles [2]. - The international market experienced a 5.39% year-on-year growth in the first half of 2025, with double-digit growth in the CIS and Middle East regions [2]. Business Segment Performance - The IVD segment generated revenue of 6.424 billion yuan, down 16.11%, but saw double-digit growth internationally, with international revenue accounting for 37% [2]. - The medical imaging segment reported revenue of 3.312 billion yuan, a decline of 22.51%, but international sales grew in the mid-to-high single digits, increasing its share to 62% [3]. - The life information and support segment achieved revenue of 5.479 billion yuan, down 31.59%, with international sales rising to 67% [3]. Profitability and Cost Structure - The company's overall gross margin decreased by 4.58 percentage points to 61.67% due to pricing pressures in the domestic market [4]. - The second quarter's gross margin was 60.84%, with a notable decline in overall net profit margin by 10.75 percentage points to 28.69% [4]. Future Outlook - Revenue projections for 2025-2027 are 37.189 billion yuan, 42.487 billion yuan, and 48.556 billion yuan, with expected growth rates of 1.26%, 14.25%, and 14.28% respectively [5]. - Net profit forecasts for the same period are 11.505 billion yuan, 13.590 billion yuan, and 15.910 billion yuan, with growth rates of -1.40%, 18.13%, and 17.07% respectively [5].

Core Viewpoint - The new healthcare policy in Guangdong aims to enhance the capabilities of village health stations, thereby activating the professional motivation of rural doctors and providing a stronger health security framework for rural residents [6][8]. Group 1: Policy Initiatives - The Guangdong Provincial Medical Security Bureau issued a notification on August 6 regarding the reform of outpatient medical insurance payment methods, which includes multiple measures to support village health stations [6][7]. - The reform addresses the weak management of chronic diseases and accessibility issues in rural areas by innovating payment mechanisms and upgrading service models [10][11]. Group 2: Key Measures - The policy optimizes the per capita payment mechanism for ordinary outpatient services at village health stations, encouraging insured individuals to choose these stations as designated institutions [12]. - It promotes the sinking of outpatient services for specific diseases, prioritizing support for village health stations to manage high-demand chronic diseases like hypertension and diabetes [15][16]. - The initiative encourages rural doctors to join family doctor teams, expanding home services and long-term prescriptions to enhance healthcare accessibility for immobile villagers [18][19]. Group 3: Expected Outcomes - The per capita payment mechanism links rural doctors' income to the overall health status of signed villagers, promoting a shift towards the role of health "gatekeepers" [20]. - The sinking of chronic disease services directly addresses grassroots pain points, significantly reducing patients' medical costs [21]. - Family doctor services integrate healthcare deeply into rural life, achieving a more compassionate approach to health protection [22]. Group 4: Challenges Ahead - Despite the positive policy changes, challenges remain, such as inadequate medical equipment at village health stations and varying professional capabilities among rural doctors [23][24]. - There is a need for increased investment to address hardware shortcomings, improve rural doctors' compensation, and enhance professional training to ensure effective policy implementation [24][25].

Group 1 - The core viewpoint of the news is the progress and achievements of China's medical insurance reform during the "14th Five-Year Plan" period, emphasizing a people-centered approach and innovation in the healthcare system [1][2] - The basic medical insurance coverage rate remains stable at around 95%, with the number of insured individuals expected to reach 1.327 billion by 2024 [1] - The cumulative balance of the medical insurance fund is projected to be 3.86 trillion yuan by the end of 2024, with a total expenditure of 12.13 trillion yuan during the "14th Five-Year Plan" period, reflecting an annual growth rate of 9.1% [2] Group 2 - The medical insurance system has implemented various measures to enhance fund security, including a comprehensive regulatory framework and the recovery of 104.5 billion yuan in misused funds [2] - As of June 2025, 2.53 million people are enrolled in maternity insurance, with total expenditures reaching 438.3 billion yuan, benefiting over 96 million individuals [2] - The use of smart healthcare services has increased, with over 1.236 billion people using medical insurance codes for direct settlement, and the online service availability rate rising from 55% in 2020 to 92% in 2024 [3]

Summary of Key Points from the Conference Call on the Pharmaceutical Industry Industry Overview - The conference call discusses the pharmaceutical industry, particularly focusing on the impact of recent government policies regarding centralized procurement and price control measures [1][2]. Core Insights and Arguments 1. **Government Regulation and Price Control**: The National Development and Reform Commission (NDRC) and the State Administration for Market Regulation are intensifying controls on price wars across various industries, including pharmaceuticals, to combat deflation [1][2]. 2. **Impact of Medical Insurance Reform**: Medical insurance reforms have led to lower drug and consumable prices but have also caused issues such as production halts, quality declines, and reduced investment in innovative drug development [1][4]. 3. **Centralized Procurement Effects**: Centralized procurement has significantly reduced drug prices, with over 70% of drugs used in public hospitals procured through this method. However, this has resulted in production stoppages and quality issues for some companies [3][4]. 4. **Support for Innovative Drugs**: The government is implementing measures to support the development of innovative drugs, including optimizing procurement rules and ensuring the stability of clinical drug supplies [1][3][6]. 5. **Future Trends in Pricing**: The rate of price reductions for drugs and consumables is expected to slow down, with domestic alternatives becoming more prevalent as the price drop from centralized procurement decreases [2][11]. Additional Important Content 1. **Challenges Faced by Companies**: Many companies are facing losses due to aggressive price competition, which has led to a reluctance to participate in negotiations for new drug listings in the medical insurance directory [4][6]. 2. **Policy Changes in Procurement**: Future procurement rules may include dynamic adjustment mechanisms and a dual regulation system for reporting quantities, aimed at improving market fairness and encouraging genuine innovation [8][9]. 3. **Monitoring and Compliance Measures**: Enhanced supervision measures are being proposed, including strict checks on production lines and the establishment of a blacklist for companies with violations [10]. 4. **Market Dynamics for Medical Devices**: The competition in the medical device sector is characterized by malicious low-price competition, particularly in imaging equipment and orthopedic implants, but policy adjustments are expected to improve this situation [12][13]. 5. **Potential Inclusion of Anesthetic Drugs in Procurement**: The likelihood of anesthetic drugs being included in centralized procurement is low due to strict regulations and limited competition among manufacturers [17][18]. This summary encapsulates the key points discussed in the conference call, highlighting the current state and future outlook of the pharmaceutical industry in light of recent regulatory changes.