2025.09.02 本文字数：3950，阅读时长大约6.5分钟 作者 |第一财经 吴斯旻 "得了癌症，还可以买商保吗？" 近年来，我国医保体系在保障覆盖范围方面取得显著进展，多种昂贵肿瘤靶向药被纳入医保乙类目录。 但"覆盖不等于可及"，一份由中疾控慢病中心、昆山杜克大学等机构研究人员共同发布的最新研究揭 示，在我国部分癌症治疗中，患者的自付比例已经接近或超过50%。伴随"带癌生存"群体逐渐增多，患 者们逐渐将目光投向商保。 尽管在谈及商业健康保险（下称"健康险"）对创新药的赔付时，大量的行业数据显示肿瘤治疗药物长年 占据"半壁江山"，但以百万医疗险为代表的补充医疗险仅服务"投保后患病"人群；惠民保作为极少数接 受恶性肿瘤患者投保的险种，既往癌症的相关治疗费用也往往被排除在赔付之外。 健康险的开发遵循"大数法则"，即通过目标客户健康风险的画像预测风险发生概率、未来的出险概率和 赔付金额，进而实现风险定价。 与此同时，保费规模增速仍然低于市场预期的健康险行业也正在寻找新的增量，供需双方的诉求在一类 小众"带病体"险种中产生交集——肿瘤复发险。 这一法则同样适用于复发险。但一个显然易见的问题在于：其他的健康险产品 ...

Core Viewpoint - Shanghai is planning a "breakthrough" initiative for collaboration between commercial insurance companies and medical institutions, focusing on cancer recurrence insurance as a key entry point [1][2] Group 1: Market Dynamics - The self-payment ratio for cancer treatment in China has reached or exceeded 50%, prompting patients to seek commercial health insurance [1] - The growth rate of premium scale in the health insurance sector is below market expectations, leading to a search for new growth areas, particularly in niche "pre-existing condition" insurance products like cancer recurrence insurance [1][3] - The market for specialized disease insurance, including cancer recurrence insurance, is still in its infancy, with only a few billion in market size compared to hundreds of billions for broader medical insurance [3] Group 2: Challenges in Product Development - The development of specialized disease insurance faces significant challenges in product design and pricing, with many products struggling to sell [1][3][5] - The insurance industry must navigate the complexities of pricing for recurrence insurance, which requires betting on disease recurrence rates and survival rates among patients [4][5] - The insurance products currently available tend to have conservative coverage designs due to affordability concerns [5] Group 3: Sales and Distribution Issues - The primary challenge for insurance companies is not pricing but rather how to effectively sell these products, as traditional sales channels are limited [6][11] - The small target population for cancer recurrence insurance, such as the estimated 6,000 breast cancer recurrence cases annually in Shanghai, complicates sales efforts [6][12] - The high sales costs and low payout rates in the insurance market further exacerbate the difficulties in selling recurrence insurance [6] Group 4: Collaboration with Medical Institutions - Successful implementation of recurrence insurance requires collaboration with hospitals and pharmaceutical companies to ensure patients receive timely and appropriate treatment [7][10] - Recent policy changes in Shanghai have allowed for pilot programs where commercial insurance can be promoted within hospitals, marking a significant shift in the market [11][12] - The integration of medical data from hospitals is crucial for developing effective recurrence insurance products, as it helps assess risk and set appropriate pricing [8][9][10] Group 5: Future Outlook - The expansion of the recurrence insurance market will depend on the ability to cover more types of cancer and other diseases with similar recurrence risks, such as cardiovascular diseases [12] - The development of specialized disease insurance products is closely tied to advancements in clinical medicine and biopharmaceutical technologies [12]