2025.11.14 本文字数：3733，阅读时长大约6分钟 作者 |第一财经 吴斯旻 惠民保面向全国推广即将进入第六年，"特药责任"俨然已成标配。据行业估算，去年惠民保以不到200 亿的保费规模贡献了约18亿元的创新药支付金额，是2021年的约9倍。 但对于全国每年约1.5亿左右的参保人而言，理赔获得感却不尽相同——有人单次获赔近80万元，有人 一年获赔了30次，但也有慢病患者"月月就医却没有一次达到起付门槛"，有患者因既往症而遭遇"赔付 减半"，还有的异地就医者、新市民被惠民保拒之门外。 低保费、高赔付率目标，叠加老年人和带病体的参保比例增加，让惠民保的发展面临"死亡螺旋"。部分 惠民保为了应对赔付压力，通过提高免赔额、下调高值药支付限额等方式，减缓保费上涨压力，却又隐 形地降低了医疗福利水平。与此同时，今年首版商保创新药目录出台后，惠民保被寄予承接该目录、增 加创新药支付的业界期待。 在此背景下，今年发布的《国家金融监督管理总局办公厅关于推动城市商业医疗险高质量发展的通知》 （下称《通知》）提出，城市商业医疗险（即惠民保）要按照商业保险的基本原则和客观规律开展业 务，坚持保费收取与保障程度相适配、扩面提 ...

Core Viewpoint - The article discusses the evolution and challenges of the "Hui Min Bao" (惠民保) insurance scheme in China, highlighting its rapid growth in coverage and the increasing complexity of claims and benefits, particularly in relation to innovative drugs and treatments [3][4][6]. Group 1: Overview of Hui Min Bao - Hui Min Bao has been promoted nationwide for nearly six years, with "special drug liability" becoming a standard feature. In the previous year, it contributed approximately 1.8 billion yuan in innovative drug payments from a premium scale of less than 20 billion yuan, marking a ninefold increase from 2021 [3][4]. - The scheme faces challenges due to varying experiences among the 150 million insured individuals, with some receiving substantial claims while others struggle to meet deductibles or face reduced payouts due to pre-existing conditions [3][4]. Group 2: Regulatory Changes and Trends - The recent notification from the National Financial Regulatory Administration emphasizes the need for commercial health insurance, including Hui Min Bao, to align premium collection with coverage levels and avoid chaotic low-price competition [4][8]. - The 2026 version of Hui Min Bao is introducing a trend of "premium stratification," moving away from low premiums to better match coverage levels, with new inclusions for chronic diseases and overseas drugs [4][6]. Group 3: Expansion of Special Drug Coverage - As of 2024, 90% of Hui Min Bao projects include "special drug liability," with a total of 672 drugs covered, reflecting a 1.8 times increase since 2021. The focus remains on cancer and rare disease medications, with over 40% of the drugs being innovative cancer treatments [6][7]. - Some regions are expanding their special drug coverage to include high-value drugs for chronic diseases, with certain plans approaching the coverage levels of pure commercial health insurance [7][8]. Group 4: Pricing and Risk Management - The core of commercial health insurance is the dynamic balance between funding and benefits. The low premium model of Hui Min Bao has slowed funding growth, impacting benefit enhancements [10][12]. - The 2026 version of Hui Min Bao is adopting a risk stratification approach, allowing for differentiated pricing based on factors like age and health status, which aims to enhance fairness and adaptability in product offerings [10][11]. Group 5: Inclusion of New Citizens and Cross-Regional Medical Services - The new Hui Min Bao products are increasingly targeting healthy individuals and young people by lowering deductibles and enhancing coverage for outpatient services and common illnesses [16][18]. - Several regions are allowing the use of personal medical insurance accounts for family members and expanding coverage to include new citizens and those seeking medical services across regions [17][18].

Core Insights - The "惠民保" (Huimin Insurance) has expanded its coverage to include chronic diseases, mental health medications, outpatient drugs, overseas drugs, and original research drugs, reflecting a shift in the insurance landscape [1][2] - The insurance scheme has seen a significant increase in claims, with approximately 18 billion yuan paid for innovative drugs in the previous year, a ninefold increase from 2021 [1] - However, the experience of claims varies widely among the 150 million insured individuals, with some facing high out-of-pocket costs due to thresholds and pre-existing conditions [1][6] Group 1: Policy Changes and Trends - The recent notification from the National Financial Regulatory Administration emphasizes the need for commercial health insurance to align premium collection with coverage levels and avoid low-price competition [2] - The 2026 version of "惠民保" has introduced a tiered premium structure, moving away from the previous low-cost model, and has expanded coverage to include more drug categories [2][3] - The number of drugs covered under "惠民保" is expected to reach 672 by 2024, with a significant focus on innovative treatments for cancer and rare diseases [3] Group 2: Coverage Expansion - The 2026 "北京普惠健康保" (Beijing Universal Health Insurance) will cover 87 disease categories and 159 drugs, including new treatments for Alzheimer's and CAR-T therapy [4] - The "齐鲁保2026版" (Qilu Insurance 2026) has expanded its coverage to include 3 high-value medical devices and additional innovative drugs for chronic conditions [4] - Many regions are now including outpatient drugs and original research drugs in their coverage, indicating a trend towards more comprehensive health insurance products [3][4] Group 3: Risk Management and Pricing Strategies - The insurance sector is adopting a risk-based pricing model, allowing for differentiated premiums based on age, health status, and pre-existing conditions [6][10] - The introduction of tiered coverage options aims to balance the need for affordable premiums with adequate benefits, particularly for high-risk groups [6][10] - Recent adjustments have led to increased reimbursement rates for patients with pre-existing conditions, reflecting a shift towards more equitable coverage [8][10] Group 4: Inclusion of New Demographics - The 2026 "惠民保" products are increasingly targeting new citizens and those seeking medical care outside their registered locations, broadening the scope of insured individuals [10][11] - Initiatives to allow family members to share health insurance accounts and to include flexible workers and retirees in coverage are being implemented in various regions [10][11] - The trend towards inclusivity aims to enhance the overall participation rate in the "惠民保" scheme, particularly among younger and healthier individuals [10]

Core Insights - The futures market in China has reached a historical high in total funds, reflecting the transformation of futures tools from "financial derivatives" to "operational necessities" during the economic transition [1][2] - The growth in the futures market is driven by a combination of policy support, industry demand, and market dynamics, indicating a positive feedback loop [3][4] Group 1: Market Dynamics - As of July 2025, the total funds in the futures market are approximately 1.82 trillion yuan, representing an 11.6% increase from the end of 2024, amidst global geopolitical tensions and economic recovery disparities [2] - The demand for hedging and asset allocation has surged due to the expansion of China's real economy, with GDP growth of 5.3% in the first half of 2025 [2] - The divergence between CPI and PPI has created a need for enterprises to lock in prices through futures to stabilize cash flow [2] Group 2: Policy and Industry Support - The increase in general corporate client equity by 18.5% by July 2025 is attributed to supportive policies, including the introduction of more futures products and fee discounts for hedging transactions [3] - Leading enterprises are increasingly reliant on futures tools for pricing and inventory management, creating a leverage effect that benefits smaller traders [3] Group 3: Futures Market Evolution - The futures market is evolving across multiple dimensions, including the introduction of carbon futures and data derivatives, indicating a shift towards more complex financial instruments [4] - The market participant structure is changing from retail-dominated to a more balanced distribution among professional institutions and industry clients [4] - Technological advancements such as blockchain and IoT are expected to streamline the delivery process, reducing costs and enhancing participation for small enterprises [4] Group 4: Service to the Real Economy - The establishment of industry chain prosperity indices can guide production and inventory management across supply chains [5] - A tiered toolbox for risk management is being developed to cater to both small and large enterprises, enhancing their ability to hedge against market fluctuations [5] - Collaborative efforts in key commodity hubs are being made to integrate logistics and financial services, providing comprehensive support to businesses [5] Group 5: Strategic Positioning - The futures market is positioned as a stabilizer for the real economy, enabling Chinese enterprises to manage risks proactively and integrate futures into their daily operations [6] - The goal is to establish "Chinese pricing" in global trade contracts, enhancing the competitiveness of Chinese businesses in the international market [6]

Core Insights - Personalized health check-ups play a crucial role in early screening and health management of chronic diseases [1] - Early detection of chronic disease risk factors is essential, as many potential health risks may be overlooked until patients exhibit clinical symptoms in advanced stages [1] - The concept of "precision stratification" in personalized health check-ups helps avoid both under-checking and over-checking, ensuring tailored health assessments [1] Group 1 - The importance of personalized health check-ups in identifying potential health risks and enhancing disease prevention effectiveness is emphasized [1] - The use of AI-driven questionnaires and big data integration to create health profiles for risk stratification is highlighted [1] - The "1+X" package model is introduced, where "1" represents essential checks for everyone, and "X" includes additional tests based on risk levels [1] Group 2 - Obesity is identified as a significant risk factor for metabolic diseases, increasing the likelihood of diabetes, hypertension, cardiovascular diseases, and tumors [2] - Various obesity-related metrics, such as waist circumference, body composition, and other health indicators, should be monitored during health check-ups [2] - A comprehensive approach to obesity intervention is recommended, focusing on lifestyle changes and personalized health management based on individual assessments [2]