Core Viewpoint - Shanghai has introduced a new set of measures aimed at enhancing the development of commercial health insurance and supporting innovation in the biopharmaceutical industry, focusing on improving the multi-payment mechanism and data sharing among medical institutions, pharmaceutical companies, and insurance providers [1][2]. Group 1: Policy Measures - The new measures, referred to as "New 18 Measures," aim to strengthen the collaboration between basic medical insurance and commercial health insurance, addressing core issues related to the application of innovative medical devices and patient payment [1][3]. - The document emphasizes the importance of data sharing among medical institutions, pharmaceutical companies, and commercial insurance companies to facilitate product development and pricing [2][3]. - The measures encourage the development of innovative commercial health insurance products that can expand basic coverage and provide reasonable pricing [3][4]. Group 2: Data Sharing and Collaboration - The new policies establish a framework for a data-sharing mechanism among medical, insurance, and pharmaceutical sectors, ensuring data security and privacy while expanding the scope of data available for product design and risk assessment [2][3]. - Insurance companies are encouraged to access historical health data in a secure environment to support the development of targeted insurance products [3][4]. - The measures aim to enhance the interaction between insurance institutions and the biopharmaceutical industry, promoting collective procurement and payment mechanisms to improve the accessibility and affordability of innovative medical devices [7]. Group 3: Targeted Insurance Products - The new measures support the development of various health insurance products, including group insurance, special disease insurance, and high-end medical services, tailored to specific populations such as the elderly and those with pre-existing conditions [2][5]. - The policies also propose using personal account balances for purchasing insurance products, thereby facilitating access to health insurance for a broader audience [5][6]. - The measures highlight the importance of group insurance products, which do not differentiate based on pre-existing conditions, as a key growth area for the health insurance industry [6]. Group 4: Financial and Operational Support - Shanghai aims to address fundamental issues affecting the commercial health insurance sector, such as funding challenges and customer acquisition difficulties, through multi-departmental collaboration [4][6]. - The new measures propose financial incentives for employers to purchase group health insurance for employees, allowing for shared premium payments and tax deductions [6][7]. - The integration of commercial health insurance with basic medical insurance is emphasized, with a focus on optimizing claims processes and expanding the coverage of innovative medical devices [6][7].

Group 1 - The core viewpoint of the article is the issuance of measures to promote the high-quality development of commercial health insurance, which aims to support innovation in the biopharmaceutical industry [1] - The measures emphasize the enhancement of the application of medical insurance data in commercial insurance settlements, optimizing the synchronous settlement model between medical insurance and commercial insurance [1] - The initiative includes the collaboration with the "Shanghai Insurance Code" platform to improve direct compensation service processes and expand access to more medical institutions and commercial health insurance products [1] Group 2 - The measures aim for full coverage of secondary and tertiary hospitals and explore extending direct compensation services to special departments and international departments of hospitals [1] - The "Shanghai Insurance Code" will be improved to enhance its "one code for all compensation" functionality, utilizing blockchain technology to build an active compensation system between medical insurance and commercial insurance [1] - The initiative also focuses on ensuring the traceability of the entire process through authorized information, transaction records, and claims results being recorded on the blockchain, thereby increasing the transparency and efficiency of the claims service [1]

Core Viewpoint - The National Healthcare Security Administration (NHSA) is leveraging healthcare data to drive innovation in the medical and health sectors, launching the "2025 National Smart Healthcare Competition" to address public welfare challenges through digital means [1][2]. Group 1: Competition Overview - The competition, initiated on August 1, 2025, is the third annual event organized by NHSA, aiming to transform innovative solutions into practical applications [1]. - This year's competition adopts a new format without specific tracks, allowing participation across over ten fields including healthcare innovation, financial insurance, and public service [2][3]. Group 2: Data Integration and Collaboration - The competition emphasizes three guiding principles: "Connecting," "Integrating," and "Opening," focusing on activating healthcare data to empower various industries [2][3]. - It will feature cross-regional integration of healthcare data from the Yangtze River Delta, providing a secure data environment for participating teams [3][6]. - NHSA aims to foster collaboration by integrating healthcare data with public data from Shanghai, enhancing the quality of data available for competition [3][5]. Group 3: Application and Future Directions - The competition will explore applications in areas such as innovative drug development, healthcare services, and intelligent fund supervision, supporting the integration of healthcare data into broader economic sectors [4][6]. - Participants will have access to real-world data, enabling them to address practical challenges in healthcare and policy adaptation [7].

Core Viewpoint - The adjustment of the National Medical Insurance Drug List for 2025 is a significant innovation aimed at enhancing the multi-tiered medical security system in China, promoting the development of innovative drugs, and improving patient access to medications [1] Group 1: Policy and Mechanism - The newly added commercial insurance innovative drug directory reflects comprehensive support for the development of innovative drugs from the payment side, facilitating the connection between commercial insurance and innovative drugs [1] - A suggestion to establish a regular communication mechanism among stakeholders, including clear negotiation rules and benefit distribution frameworks, is proposed to enhance collaboration [2] - The core value of the commercial insurance directory is to address the access challenges of innovative drugs, particularly those that are high-value but currently not covered by basic medical insurance [2] Group 2: Product Design and Patient Access - The design of health insurance products should adopt a "core protection + flexible options" approach, ensuring basic coverage for urgently needed innovative drugs while offering differentiated options based on premium levels [3] - A dynamic adjustment mechanism based on the drug protection list is recommended to regularly evaluate drug usage and optimize coverage [3] Group 3: Pricing and Payment Mechanisms - To enhance the accessibility of innovative drugs, a balanced approach between pharmaceutical company profits and commercial insurance payout pressures is necessary [4] - Suggestions include optimizing hospital drug management policies and lowering payment thresholds by allowing the use of personal medical insurance accounts for purchasing drugs [4] Group 4: Collaborative Framework - A collaborative mechanism involving government guidance, market operation, and social participation is recommended to support the negotiation and implementation of the drug directory [5] - The establishment of a cross-departmental joint meeting system is suggested to regularly coordinate and resolve issues during the implementation process [5]