Core Insights - The transition of Huiminbao from "post-compensation" to "prevention" is highlighted, indicating a shift in focus towards proactive health management and risk reduction in the insurance sector [1][4] Group 1: Market Dynamics - The payment paradox between insurance companies and pharmaceutical firms is discussed, where insurers aim to cover healthy individuals to control costs, while drug companies focus on medication usage for market value [1] - The expected market size for innovative drug sales in 2024 is projected to reach 162 billion yuan, with commercial health insurance expenditures estimated at 12.4 billion yuan, contributing only 7.7% [1] - Huiminbao's share in the compensation for innovative drugs is 15%, which is lower than disease insurance and million medical insurance, accounting for 47% and 22% respectively [1] Group 2: Product Development and Challenges - The proportion of normally operating Huiminbao products decreased from 74.3% in 2023 to 66.68% in 2024, indicating ongoing challenges in market performance [3] - The decline in Huiminbao product numbers is attributed to lower-than-expected participation rates and difficulties in expanding the risk pool [3] - New product offerings are being introduced, such as health check management services, to enhance participant engagement and address operational pressures [3] Group 3: Health Management Integration - The integration of health management into commercial health products is emphasized as a means to reduce the risk of major diseases through early detection and intervention [4] - The model of "health management + Huiminbao" aims to shift the focus from post-event compensation to preemptive measures, enriching risk management strategies [4] - The combination of preventive health checks and innovative drug coverage is seen as a significant advancement in insurance, potentially lowering the disease burden on the population [4] Group 4: Industry Trends - The rise of health management services in insurance has been noted since 2016, although growth remains slow due to a lack of experience in managing medical models [5] - The potential of commercial health insurance in the innovative drug payment sector is yet to be fully realized, with ongoing exploration needed for deeper integration of technology, payment, and value [5]

Core Viewpoint - The medical insurance system in Dezhou has shown significant progress in the first half of 2025, with various initiatives enhancing the public's sense of security regarding medical insurance [3][4][12]. Group 1: Medical Insurance Fund Performance - In the first half of 2025, the total income of the city's medical insurance fund was 3.886 billion, while total expenditure reached 4.607 billion, resulting in a cumulative balance of 7.352 billion [4]. - The employee medical insurance fund generated an income of 2.349 billion, a year-on-year increase of 6.68%, with expenditures of 1.991 billion, up 3.54% [4]. - The resident medical insurance fund had an income of 1.537 billion and expenditures of 2.616 billion, with a budget execution rate of 54.81% [4]. Group 2: Healthcare Reform and Initiatives - The city has implemented a "Three Medical Linkage + Traditional Chinese Medicine" reform, resulting in savings of 755 million from drug and consumable procurement [5]. - The "Dezhou Huimin Bao" commercial insurance program has seen participation from 334,800 individuals by the end of June [5]. - The city has expanded the number of designated medical institutions for traditional Chinese medicine from 81 to 115 [5]. Group 3: Service Capability Enhancement - The medical insurance settlement process has been optimized, reducing the settlement cycle to 15 working days [6]. - The city aims to cover 5.074 million insured individuals by 2025, with an additional 49,500 new participants this year [6]. - The online processing of medical expense reimbursements reached 12.2045 million cases in the first half of the year [6]. Group 4: Fund Supervision and Management - The city recovered and returned 22.1135 million in medical insurance funds and imposed administrative penalties totaling 3.4545 million in the first half of the year [8]. - A credit and joint supervision system has been established to manage the qualifications of personnel in designated medical institutions [9]. Group 5: Ongoing Reforms and Innovations - The city has implemented reforms in major disease medical insurance and assistance systems, benefiting 110,100 individuals with a total expenditure of 43.0352 million [10]. - The average hospitalization cost has decreased by 6.57% compared to the previous year, with personal hospitalization burdens reduced by 6.84% [10]. - The city has introduced a unified major disease insurance fund, saving 85 million in resident fund expenditures [11]. Group 6: Future Directions - The medical insurance bureau plans to continue deepening reforms and ensuring comprehensive coverage for the population, aiming to enhance the quality of medical insurance services [12].