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医保商保协同发展 加速创新药械惠及百姓 上海建立全国首个系统性构建商业健康保险与生物医药产业创新“双向赋能”机制
Jie Fang Ri Bao· 2025-08-07 01:57
Core Viewpoint - The era of collaborative development between medical insurance and commercial insurance has arrived, as evidenced by recent policy changes and initiatives aimed at enhancing the synergy between commercial health insurance and the biopharmaceutical industry [1][2]. Group 1: Policy Initiatives - In July 2023, Shanghai introduced 28 measures to support the development of innovative drugs and medical devices, which has sparked industry discussions and set a precedent for nationwide implementation [1]. - Recently, seven departments in Shanghai released 18 specific measures to promote the high-quality development of commercial health insurance, focusing on payment mechanisms, data sharing, service models, and regulatory innovation [1][4]. - The 18 measures represent a systematic approach to creating a dual empowerment mechanism between commercial health insurance and biopharmaceutical innovation, emphasizing the need for diverse payment mechanisms beyond basic medical insurance [1][4]. Group 2: Highlights of Commercial Health Insurance Innovation - One highlight is the support for "pre-existing condition" insurance, allowing the trial development of insurance products for patients with chronic diseases under a regulatory sandbox mechanism [3]. - The measures also aim to activate individual medical account funds, permitting eligible group health insurance to use accumulated personal account balances for payments [3]. - There is encouragement for "insurance + service" models, promoting the development of long-term care insurance and collaboration between insurance companies and health service providers [3]. Group 3: Focus on Group Health Insurance - The 18 measures will prioritize the development of group health insurance, which has proven to be a mature sector, particularly in providing customized corporate supplementary medical insurance [3][4]. - Group health insurance can effectively cover pre-existing conditions and chronic diseases, addressing adverse selection issues while expanding funding and improving management efficiency [3]. - The measures will also focus on innovative drugs and medical devices, encouraging the insurance industry to develop exemplary clauses for group health insurance that include new medical technologies and products [4]. Group 4: Future Outlook for Consumers - The future of insurance products is expected to be more diverse, with broader coverage and more efficient services, reducing the economic burden of using innovative drugs and medical devices for consumers [5]. - Shanghai plans to optimize existing insurance products and develop specialized offerings for specific demographics, such as the elderly and those with pre-existing conditions [5]. - The implementation of policies will continue to signal positive developments in the market, with efforts to eliminate payment bottlenecks for innovative drug applications and support the growth of the biopharmaceutical industry [5].