联合研究 基本医保作为我国医疗体系的重要支付方，近年来压力显现；为构建更健康可持续的支付体系 ，我国正处于医疗改革转型的重要时期。在 当下紧平衡的背景下，医保定位于"保基本"[1]，面对日益增长的医疗需求与支付端缺口的矛盾，我们认为商保或可发挥其社会管理功能、 在变革趋势中成为重要的筹资和支付方。承接 中国商业健康险系列1）：现状、困境与破局 ，本文着重通过梳理医保改革脉络，展望我国 多层次医疗保障体系的发展方向。（文章有删减，完整内容详见报告原文） Abstract 摘要 政策力度、行业基建不及预期；居民意识提升慢于预期。 Text 正文 多重因素影响，医保收支平衡压力显现 医保基金为我国医疗的主要支付方，当下处于相对紧平衡状态 我国卫生支付体系呈现多元化趋势，医保当前为支付主力。 我国卫生支付体系中，若不考虑以基建投入、公共卫生服务为主的政府卫生支出和慈善、捐 赠等较小组成部分，2024年医保支出、商保支出、自费支出合计金额5.8万亿元，医保承担其中51%，商保占7%，自费比例达到42%，基本医疗保险目前 仍然是我国卫生支付体系当中的最大支付方。 医保收支平衡压力显现，改革进入关键阶段，行业经历阵痛。 受 ...

Group 1: Innovation and Internationalization - The trend of innovation going abroad is clear, with pharmaceuticals leading the way and medical devices also expected to follow suit. The reform in drug approval continues to yield benefits, supported by domestic engineering talent, abundant clinical resources, and favorable policies, allowing Chinese innovative drugs to transition from imitation to FIC/BIC innovation [2][4][5] - Chinese innovative drugs are entering the international stage, with the industry moving from "import imitation" to "innovation output." The total amount of license-out transactions for Chinese pharmaceutical companies reached $40.8 billion in the first half of 2025, a 96% year-on-year increase, indicating a growing international competitiveness [5][10] - The medical device sector is also accelerating its international expansion, with overseas revenue growth outpacing total revenue growth, as companies enhance their global sales networks and product offerings [10][12] Group 2: Domestic Demand and Insurance Developments - Domestic demand is gradually improving after a period of weakness, with the impact of medical anti-corruption measures expected to ease by 2025. The introduction of policies to combat "involution" is reflected in the loosening price anchors for the first batch of generic drug procurement [11][12] - The development of commercial insurance is seen as a key factor in alleviating payment conflicts within the healthcare system. The push for a multi-tiered medical insurance system is gaining momentum, with commercial insurance expected to play a crucial role in expanding the domestic market [12][13] - The establishment of a commercial insurance directory for innovative drugs in 2025 is anticipated to enhance the payment capabilities for innovative products, supporting the balance between basic insurance and innovation [13] Group 3: Investment Strategies and Market Outlook - The "dumbbell strategy" for 2026 emphasizes a dual focus on technological advancement and traditional defensive sectors. The rapid development of AI in healthcare is highlighted, with the potential for significant advancements in the industry [3][14] - Traditional pharmaceutical companies are expected to experience a new cycle of high-quality development driven by state-owned enterprise reforms and technological innovation, making them a stable investment option amidst various market pressures [14]