"支持商业健康保险与基本医保衔接互补、差异化发展。积极落地商保创新药品目录，鼓励商业健康保 险将更多基本医保目录外的合理医疗费用纳入保障范围。鼓励商业健康保险机构扩大对创新药的投资规 模，促进创新药研发。"会议称。 一种业界观点认为，在商业健康险市场规模逼近万亿级之后，很难维持两位数增速，其发展势必需要从 "单一追求规模增长"转为"稳扎稳打地调结构"，推出更多惠及老年人和带病体，满足多元化需求的多层 次创新产品。但目前商保创新仍然处于"拿着菜单点菜"的阶段，要想真正发挥商保推动新药、新技术临 床应用的作用，实现参保人健康风险减量，仍有很长一段路需要走。 目前商保创新仍然处于"拿着菜单点菜"的阶段 2025年被业界视为商业健康险"元年"，这一年商保创新药目录发布，监管部门鼓励开发带病体保险创 新、规范惠民保发展的信号接连发出，医保数据开放也取得实质性进展。 近日召开的2025年全国医疗保障工作会议在部署下一年工作时，继去年后再度提及"商业健康险"，同时 还首次将"支持商业健康保险发展"置于"健全多层次医疗保障体系"之前，加以强调。 在即将到来的2026年里，商业健康险有哪些值得关注的创新趋势？第一财经梳理了三大 ...

Core Viewpoint - The article discusses the current status, challenges, and potential breakthroughs of commercial health insurance in China, emphasizing its significant social management function in addressing the medical expense payment gap and improving healthcare accessibility [2][10]. Current Status - On a macro level, self-paid medical expenses account for a high proportion of total healthcare costs in China, with personal out-of-pocket expenses reaching 2.5 trillion yuan, representing 27% of total healthcare expenditure in 2023 [12]. - The commercial health insurance payout in 2023 was only 0.4 trillion yuan, accounting for 4% of total healthcare costs, indicating a significant gap in coverage [12]. - The basic medical insurance system covers over 1.3 billion people, achieving a participation rate of around 95%, but it is constrained in its ability to further increase payment proportions due to rising healthcare costs and demographic changes [15][21]. Challenges - The effective supply of commercial health insurance is insufficient, primarily due to a lack of industry infrastructure and product development capabilities [5][25]. - The perception of adequate coverage from basic medical insurance leads to a "sufficient protection illusion," which hinders the demand for commercial health insurance [36]. - The insurance industry has historically focused on rapid expansion through high-premium critical illness insurance, which has limited the development of more integrated health insurance products [43][44]. Potential Breakthroughs - Key variables for breaking the current deadlock include reforms in medical insurance payment systems and support from regulatory bodies to enhance industry infrastructure [5][51]. - The promotion of personal account-based medical insurance and long-term care insurance could provide comprehensive health solutions and open new avenues for industry growth [64][65]. - The increasing income levels and the growing middle-income population in China are expected to drive demand for commercial health insurance, creating a favorable environment for its development [62]. Investment Opportunities - The article identifies four main investment themes: leading internet platforms and large insurance groups building commercial health insurance systems, efficient corporate group insurance channels, reinsurers benefiting from health insurance market growth, and pharmaceutical companies gaining from increased commercial insurance payments [6][66].