商业健康保险创新

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上海:深化医疗、医保和商保数据共享机制,深化创新药械支付机制创新
Xin Lang Cai Jing· 2025-08-06 11:20
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].