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Medical Network, August 25, recently, PhIRDA and RDPAC jointly released the report "Multi-level Medical Security System Boosts People's Health and High-quality Industrial Development".
This report is the third in a series of reports "Building China's Pharmaceutical Innovation Ecosystem".
It aims to start from the current situation and challenges of China's medical security system and innovative drug payment system, and learn from the mature experience of the construction and development of multi-level medical security systems in Germany, the United States, France, Australia and other countries to improve China's multi-level medical security System construction
.
This report is the third in a series of reports "Building China's Pharmaceutical Innovation Ecosystem".
It aims to start from the current situation and challenges of China's medical security system and innovative drug payment system, and learn from the mature experience of the construction and development of multi-level medical security systems in Germany, the United States, France, Australia and other countries to improve China's multi-level medical security System construction
.
This report answers the following three questions through research: First, from the demand level, what needs should be covered by commercial health insurance (including supplementary medical insurance)? Second, from the population level, who should be covered by commercial health insurance? Third, how should the government participate in the construction of multi-level medical security?
01 Current Status of China's Commercial Health Insurance
As of 2020, China's basic medical insurance system has covered 1.
361 billion people, almost universal coverage, and has developed from a single hospitalization plan to a comprehensive plan for outpatients and hospitalizations.
It has established a protection and assistance system for major and major diseases, and the scope of medication has been further expanded
.
361 billion people, almost universal coverage, and has developed from a single hospitalization plan to a comprehensive plan for outpatients and hospitalizations.
It has established a protection and assistance system for major and major diseases, and the scope of medication has been further expanded
.
However, compared with developed countries, China's per capita expenditure on basic medical insurance is relatively low, which is only about 1/10-1/15 of that of developed countries in Europe
.
Even by 2025, if medical insurance expenditure reaches about 4 trillion yuan, China's per capita medical insurance expenditure will still be significantly lower than that of developed countries
.
.
Even by 2025, if medical insurance expenditure reaches about 4 trillion yuan, China's per capita medical insurance expenditure will still be significantly lower than that of developed countries
.
On the other hand, although the dynamic adjustment of the medical insurance catalogue gradually established since 2017 has been effective and improved the accessibility of innovative drugs, overall, the proportion of innovative drugs in China's drug costs is not high
.
Data shows that in 2018, the cost of patented original research drugs in China only accounted for 9%, while the proportion of European and American countries has reached more than 40%.
The per capita GDP of Turkey, Russia, Mexico, Brazil, Indonesia, South Africa, etc.
is similar to or lower than that of China.
This proportion of the country also exceeds 20%
.
.
Data shows that in 2018, the cost of patented original research drugs in China only accounted for 9%, while the proportion of European and American countries has reached more than 40%.
The per capita GDP of Turkey, Russia, Mexico, Brazil, Indonesia, South Africa, etc.
is similar to or lower than that of China.
This proportion of the country also exceeds 20%
.
For the innovative drug industry that is in the "introduction period" and the early "growth period", a reasonable price level is also needed for protection and incentives
.
However, in recent years, medical insurance has achieved a significant price reduction effect through "soul bargaining".
At the same time, China's drug patents have been maintained for a short period of time.
The growth period of innovative drugs is often short.
There are often premature profits or even losses, and it is difficult for pharmaceutical companies to be effective.
Make up for the R&D cost invested in the early stage
.
.
However, in recent years, medical insurance has achieved a significant price reduction effect through "soul bargaining".
At the same time, China's drug patents have been maintained for a short period of time.
The growth period of innovative drugs is often short.
There are often premature profits or even losses, and it is difficult for pharmaceutical companies to be effective.
Make up for the R&D cost invested in the early stage
.
Therefore, it is imperative to build a multi-level medical security system to meet medical and health needs
.
.
The report predicts that commercial health insurance will become the main growth driver for the "multi-level medical security system
.
" The current commercial health insurance market is showing a huge growth trend: in the past five years, the income of commercial health insurance premiums (including corporate supplementary medical insurance) has jumped from 241.
1 billion yuan in 2015 to 706.
6 billion yuan in 2019, an annual increase The speed is as high as 31%
.
.
" The current commercial health insurance market is showing a huge growth trend: in the past five years, the income of commercial health insurance premiums (including corporate supplementary medical insurance) has jumped from 241.
1 billion yuan in 2015 to 706.
6 billion yuan in 2019, an annual increase The speed is as high as 31%
.
At the same time, the government also attaches great importance to promoting the development of commercial health insurance
.
At the beginning of 2020, the "Opinions on Promoting the Development of Commercial Insurance in Social Services" jointly issued by 13 departments including the China Banking and Insurance Regulatory Commission clearly stated the goal of striving to exceed 2 trillion yuan in commercial health insurance premiums by 2025
.
The report predicts that in the future, commercial health insurance can provide a source of 18% of the total health expenses and become a major contributor to medical insurance
.
.
At the beginning of 2020, the "Opinions on Promoting the Development of Commercial Insurance in Social Services" jointly issued by 13 departments including the China Banking and Insurance Regulatory Commission clearly stated the goal of striving to exceed 2 trillion yuan in commercial health insurance premiums by 2025
.
The report predicts that in the future, commercial health insurance can provide a source of 18% of the total health expenses and become a major contributor to medical insurance
.
However, the analysis of the report shows that the overall protection level of China's commercial health insurance is not high and the boundaries of responsibility are not clear.
It is difficult for high-risk and sick people to participate in insurance.
The sustainability of the development of urban inclusive insurance, which has received widespread attention, still needs time to test
.
In terms of actual insurance participation, only about 40% of the individual insurance premiums (including corporate supplementary medical insurance) are limited to healthy people.
The insured population is limited, and the product payout is relatively low, about 33%, which affects the entire medical insurance system.
The contribution is limited
.
It is difficult for high-risk and sick people to participate in insurance.
The sustainability of the development of urban inclusive insurance, which has received widespread attention, still needs time to test
.
In terms of actual insurance participation, only about 40% of the individual insurance premiums (including corporate supplementary medical insurance) are limited to healthy people.
The insured population is limited, and the product payout is relatively low, about 33%, which affects the entire medical insurance system.
The contribution is limited
.
On the other hand, the boundary between commercial insurance and medical insurance is blurred.
In particular, corporate supplementary insurance and outpatient medical insurance overlap.
About 75% of commercial health insurance does not cover services or medicines other than medical insurance, and there is a lack of long-term medical insurance products
.
From the perspective of guaranteeing the availability of innovative drugs, the popularization of innovative drugs can reduce the social costs caused by diseases.
Under the current situation that medical insurance is the main payer of innovative drugs, the development of payment channels other than medical insurance such as commercial health insurance will help you The sustained and healthy development of the medical insurance system is crucial, but the current commercial insurance contributes a relatively low proportion of drug expenditures, and the coverage is mainly based on the drugs in the medical insurance catalogue
.
In particular, corporate supplementary insurance and outpatient medical insurance overlap.
About 75% of commercial health insurance does not cover services or medicines other than medical insurance, and there is a lack of long-term medical insurance products
.
From the perspective of guaranteeing the availability of innovative drugs, the popularization of innovative drugs can reduce the social costs caused by diseases.
Under the current situation that medical insurance is the main payer of innovative drugs, the development of payment channels other than medical insurance such as commercial health insurance will help you The sustained and healthy development of the medical insurance system is crucial, but the current commercial insurance contributes a relatively low proportion of drug expenditures, and the coverage is mainly based on the drugs in the medical insurance catalogue
.
02 countries learn from experience
Commercial health insurance plays a very important role in many countries around the world
.
From the perspective of demand-level protection, according to the "European Health System and Policy Observation" summary of commercial health insurance in middle and high-income countries, commercial health insurance mainly plays four roles: complementary commercial health insurance and complementary commercial health insurance -Self-paid supplementary and supplementary commercial health insurance-Supplementary and alternative commercial health insurance outside of medical insurance
.
.
From the perspective of demand-level protection, according to the "European Health System and Policy Observation" summary of commercial health insurance in middle and high-income countries, commercial health insurance mainly plays four roles: complementary commercial health insurance and complementary commercial health insurance -Self-paid supplementary and supplementary commercial health insurance-Supplementary and alternative commercial health insurance outside of medical insurance
.
Among the representative countries in the main commercial health insurance market, the main coverage responsibilities of commercial health insurance are different
.
.
Take the United States as an example.
The U.
S.
medical insurance system is dominated by commercial health insurance, covering about 55% of the population (employer insurance accounts for 49% and personal insurance accounts for 6%); followed by government-led Medicare and Medicaid plans.
Covering approximately 17% and 18% of the U.
S.
population respectively; the protection plan for the other 2% of the population is provided by the U.
S.
military; only about 8% of the remaining population does not have a health insurance plan
.
The U.
S.
medical insurance system is dominated by commercial health insurance, covering about 55% of the population (employer insurance accounts for 49% and personal insurance accounts for 6%); followed by government-led Medicare and Medicaid plans.
Covering approximately 17% and 18% of the U.
S.
population respectively; the protection plan for the other 2% of the population is provided by the U.
S.
military; only about 8% of the remaining population does not have a health insurance plan
.
In 2016, the total expenditure on health insurance in the United States was approximately US$2.
4 trillion, of which commercial health insurance expenditure accounted for 48%, Medicare expenditure accounted for 28%, and Medicaid expenditure accounted for 24%
.
Since Medicare insurance in the United States is basically universal coverage, it is similar to social insurance in China
.
There are 5 types of Medicare:
4 trillion, of which commercial health insurance expenditure accounted for 48%, Medicare expenditure accounted for 28%, and Medicaid expenditure accounted for 24%
.
Since Medicare insurance in the United States is basically universal coverage, it is similar to social insurance in China
.
There are 5 types of Medicare:
Throughout the history of the development of commercial health insurance in the United States, corporate group insurance has played an extremely important role
.
After World War II, due to a large labor shortage and high inflation, the United States passed the "1942 Stablization Act" to restrict companies from paying excessively high wages for their employees
.
However, companies are not restricted in purchasing medical benefits for their employees, and at the same time they can be tax-exempt.
This stage promotes the U.
S.
health insurance to an employer-based structure
.
By 1955, the U.
S.
corporate group insurance coverage rate had increased to about 70%, and it was about 10% before World War II
.
.
After World War II, due to a large labor shortage and high inflation, the United States passed the "1942 Stablization Act" to restrict companies from paying excessively high wages for their employees
.
However, companies are not restricted in purchasing medical benefits for their employees, and at the same time they can be tax-exempt.
This stage promotes the U.
S.
health insurance to an employer-based structure
.
By 1955, the U.
S.
corporate group insurance coverage rate had increased to about 70%, and it was about 10% before World War II
.
By the 1960s, the lack of security for vulnerable groups such as the elderly and the disabled gradually aroused widespread public concern.
Therefore, the government intervened to establish Medicare and Medicaid based on social security, and combined social security financing and personal financing to solve the participation of this part of the population.
Guarantee problem
.
Therefore, the government intervened to establish Medicare and Medicaid based on social security, and combined social security financing and personal financing to solve the participation of this part of the population.
Guarantee problem
.
The problem that people with the disease could not be insured was finally resolved in 2010 through government participation
.
In 2010, about 17.
8% of the non-elderly population in the United States still had no medical insurance.
In 2010, the Obama administration promoted the passage of the "Affordable Patient Act", which is the most breakthrough medical insurance bill in the United States since the Medicare and Medicaid plans were enacted in 1965.
.
.
In 2010, about 17.
8% of the non-elderly population in the United States still had no medical insurance.
In 2010, the Obama administration promoted the passage of the "Affordable Patient Act", which is the most breakthrough medical insurance bill in the United States since the Medicare and Medicaid plans were enacted in 1965.
.
All in all, the policies of European and American countries generally reflect the characteristics of "separation of management and operation" in the way of participating in commercial health insurance
.
In terms of "management", the medical security system is generally clearly regulated through legislative means
.
Taking Germany as an example, the "Sickness Social Insurance Law" passed by the parliament at the end of the 18th century is the world's earliest bill related to the medical security system.
It stipulates that all workers engaged in industrial economic activities (except agricultural workers) shall be subject to compulsory sickness social insurance
.
Since then, Germany has successively promulgated more than ten relevant laws, such as the "Employee Insurance Law", "The First Controlling Medical Expenses Law", the " Hospital Medical Expenses Control Law" and the "Medical Insurance Structure Law" at different stages of development
.
Developed countries such as the United Kingdom, France, the Netherlands, the United States, Israel, and Australia also mainly use legislation to provide detailed regulations on the medical security system
.
.
In terms of "management", the medical security system is generally clearly regulated through legislative means
.
Taking Germany as an example, the "Sickness Social Insurance Law" passed by the parliament at the end of the 18th century is the world's earliest bill related to the medical security system.
It stipulates that all workers engaged in industrial economic activities (except agricultural workers) shall be subject to compulsory sickness social insurance
.
Since then, Germany has successively promulgated more than ten relevant laws, such as the "Employee Insurance Law", "The First Controlling Medical Expenses Law", the " Hospital Medical Expenses Control Law" and the "Medical Insurance Structure Law" at different stages of development
.
Developed countries such as the United Kingdom, France, the Netherlands, the United States, Israel, and Australia also mainly use legislation to provide detailed regulations on the medical security system
.
European and American countries have a relatively clear granularity of legislation, and a series of legal regulations are imposed on the population, scope, encouragement and restriction policies of social insurance and commercial health insurance
.
Take Australia as an example.
Its "Private Health Insurance Act 2007" adopts hundreds of detailed regulations, provides and incentives to encourage people to purchase private commercial health insurance, and also stipulates the planning of private health insurance products
.
.
Take Australia as an example.
Its "Private Health Insurance Act 2007" adopts hundreds of detailed regulations, provides and incentives to encourage people to purchase private commercial health insurance, and also stipulates the planning of private health insurance products
.
In terms of "office", the administrative department mainly supervises and enforces legal provisions
.
The regulatory bodies for commercial health insurance are divided into three models: one is the supervision of financial management agencies, such as the French Prudential Regulation and Resolution Agency (ACPR); the other is the establishment of a special commercial health insurance management part in the health sector, such as the Brazilian national private Health Insurance Regulatory Agency (ANS); the third is unified management by the subordinate units of the health department, such as the US Federal Medical Insurance and Medical Assistance Service (CMS)
.
.
The regulatory bodies for commercial health insurance are divided into three models: one is the supervision of financial management agencies, such as the French Prudential Regulation and Resolution Agency (ACPR); the other is the establishment of a special commercial health insurance management part in the health sector, such as the Brazilian national private Health Insurance Regulatory Agency (ANS); the third is unified management by the subordinate units of the health department, such as the US Federal Medical Insurance and Medical Assistance Service (CMS)
.
03Multi -level guarantee policy recommendations
Combining international experience and suggestions from domestic experts, this report puts forward suggestions from four aspects:
At the level of top-level design for perfecting multi-level guarantees
.
First, pass legislation to further clarify the relationship between the various levels of multi-level protection.
First, the payment scope and payment level boundaries of medical insurance should be clarified to clarify the development space for commercial insurance.
Second, commercial health insurance should cover multi-level needs and respond to needs at all levels Clearly defined
.
The second is to clarify the government organization setting of commercial health insurance
.
.
First, pass legislation to further clarify the relationship between the various levels of multi-level protection.
First, the payment scope and payment level boundaries of medical insurance should be clarified to clarify the development space for commercial insurance.
Second, commercial health insurance should cover multi-level needs and respond to needs at all levels Clearly defined
.
The second is to clarify the government organization setting of commercial health insurance
.
In terms of promoting the sustainable development of commercial health insurance, it is recommended that the National Medical Insurance Administration, together with the Ministry of Finance and the China Banking and Insurance Regulatory Commission, actively promote the development of urban inclusive insurance, and local governments should promote the implementation of local urban inclusive insurance
.
For example, Beijing recently launched the Urban Inclusive Insurance
.
At the same time, it is recommended that innovative drugs with high clinical value but not included in the national medical insurance catalogue be used as the "basic supplementary layer"
.
.
For example, Beijing recently launched the Urban Inclusive Insurance
.
At the same time, it is recommended that innovative drugs with high clinical value but not included in the national medical insurance catalogue be used as the "basic supplementary layer"
.
To improve the efficient use of medical insurance funds, improve the dynamic adjustment mechanism of the medical insurance catalog, and establish a value-oriented, scientific, objective, open and transparent medical insurance catalog adjustment mechanism
.
.
In promoting the integration and linkage of medical insurance and commercial insurance, exploration and breakthroughs can be made in the payment of innovative drugs
.
For example, adjust the medical insurance payment standard operating mechanism, while keeping the medical insurance payment standard confidential, allow the actual market price to be higher than the medical insurance payment standard, and encourage the part higher than the payment standard to be included in the scope of commercial health insurance coverage
.
At the same time, explore the payment model of risk sharing
.
.
For example, adjust the medical insurance payment standard operating mechanism, while keeping the medical insurance payment standard confidential, allow the actual market price to be higher than the medical insurance payment standard, and encourage the part higher than the payment standard to be included in the scope of commercial health insurance coverage
.
At the same time, explore the payment model of risk sharing
.
Medical Network, August 25, recently, PhIRDA and RDPAC jointly released the report "Multi-level Medical Security System Boosts People's Health and High-quality Industrial Development".
This report is the third in a series of reports "Building China's Pharmaceutical Innovation Ecosystem".
It aims to start from the current situation and challenges of China's medical security system and innovative drug payment system, and learn from the mature experience of the construction and development of multi-level medical security systems in Germany, the United States, France, Australia and other countries to improve China's multi-level medical security System construction
.
This report is the third in a series of reports "Building China's Pharmaceutical Innovation Ecosystem".
It aims to start from the current situation and challenges of China's medical security system and innovative drug payment system, and learn from the mature experience of the construction and development of multi-level medical security systems in Germany, the United States, France, Australia and other countries to improve China's multi-level medical security System construction
.
This report answers the following three questions through research: First, from the demand level, what needs should be covered by commercial health insurance (including supplementary medical insurance)? Second, from the population level, who should be covered by commercial health insurance? Third, how should the government participate in the construction of multi-level medical security?
01 Current Status of China's Commercial Health Insurance
As of 2020, China's basic medical insurance system has covered 1.
361 billion people, almost universal coverage, and has developed from a single hospitalization plan to a comprehensive plan for outpatients and hospitalizations.
It has established a protection and assistance system for major and major diseases, and the scope of medication has been further expanded
.
361 billion people, almost universal coverage, and has developed from a single hospitalization plan to a comprehensive plan for outpatients and hospitalizations.
It has established a protection and assistance system for major and major diseases, and the scope of medication has been further expanded
.
However, compared with developed countries, China's per capita expenditure on basic medical insurance is relatively low, which is only about 1/10-1/15 of that of developed countries in Europe
.
Even by 2025, if medical insurance expenditure reaches about 4 trillion yuan, China's per capita medical insurance expenditure will still be significantly lower than that of developed countries
.
.
Even by 2025, if medical insurance expenditure reaches about 4 trillion yuan, China's per capita medical insurance expenditure will still be significantly lower than that of developed countries
.
On the other hand, although the dynamic adjustment of the medical insurance catalogue gradually established since 2017 has been effective and improved the accessibility of innovative drugs, overall, the proportion of innovative drugs in China's drug costs is not high
.
Data shows that in 2018, the cost of patented original research drugs in China only accounted for 9%, while the proportion of European and American countries has reached more than 40%.
The per capita GDP of Turkey, Russia, Mexico, Brazil, Indonesia, South Africa, etc.
is similar to or lower than that of China.
This proportion of the country also exceeds 20%
.
.
Data shows that in 2018, the cost of patented original research drugs in China only accounted for 9%, while the proportion of European and American countries has reached more than 40%.
The per capita GDP of Turkey, Russia, Mexico, Brazil, Indonesia, South Africa, etc.
is similar to or lower than that of China.
This proportion of the country also exceeds 20%
.
For the innovative drug industry that is in the "introduction period" and the early "growth period", a reasonable price level is also needed for protection and incentives
.
However, in recent years, medical insurance has achieved a significant price reduction effect through "soul bargaining".
At the same time, China's drug patents have been maintained for a short period of time.
The growth period of innovative drugs is often short.
There are often premature profits or even losses, and it is difficult for pharmaceutical companies to be effective.
Make up for the R&D cost invested in the early stage
.
.
However, in recent years, medical insurance has achieved a significant price reduction effect through "soul bargaining".
At the same time, China's drug patents have been maintained for a short period of time.
The growth period of innovative drugs is often short.
There are often premature profits or even losses, and it is difficult for pharmaceutical companies to be effective.
Make up for the R&D cost invested in the early stage
.
Therefore, it is imperative to build a multi-level medical security system to meet medical and health needs
.
.
The report predicts that commercial health insurance will become the main growth driver for the "multi-level medical security system
.
" The current commercial health insurance market is showing a huge growth trend: in the past five years, the income of commercial health insurance premiums (including corporate supplementary medical insurance) has jumped from 241.
1 billion yuan in 2015 to 706.
6 billion yuan in 2019, an annual increase The speed is as high as 31%
.
.
" The current commercial health insurance market is showing a huge growth trend: in the past five years, the income of commercial health insurance premiums (including corporate supplementary medical insurance) has jumped from 241.
1 billion yuan in 2015 to 706.
6 billion yuan in 2019, an annual increase The speed is as high as 31%
.
At the same time, the government also attaches great importance to promoting the development of commercial health insurance
.
At the beginning of 2020, the "Opinions on Promoting the Development of Commercial Insurance in Social Services" jointly issued by 13 departments including the China Banking and Insurance Regulatory Commission clearly stated the goal of striving to exceed 2 trillion yuan in commercial health insurance premiums by 2025
.
The report predicts that in the future, commercial health insurance can provide a source of 18% of the total health expenses and become a major contributor to medical insurance
.
.
At the beginning of 2020, the "Opinions on Promoting the Development of Commercial Insurance in Social Services" jointly issued by 13 departments including the China Banking and Insurance Regulatory Commission clearly stated the goal of striving to exceed 2 trillion yuan in commercial health insurance premiums by 2025
.
The report predicts that in the future, commercial health insurance can provide a source of 18% of the total health expenses and become a major contributor to medical insurance
.
However, the analysis of the report shows that the overall protection level of China's commercial health insurance is not high and the boundaries of responsibility are not clear.
It is difficult for high-risk and sick people to participate in insurance.
The sustainability of the development of urban inclusive insurance, which has received widespread attention, still needs time to test
.
In terms of actual insurance participation, only about 40% of the individual insurance premiums (including corporate supplementary medical insurance) are limited to healthy people.
The insured population is limited, and the product payout is relatively low, about 33%, which affects the entire medical insurance system.
The contribution is limited
.
It is difficult for high-risk and sick people to participate in insurance.
The sustainability of the development of urban inclusive insurance, which has received widespread attention, still needs time to test
.
In terms of actual insurance participation, only about 40% of the individual insurance premiums (including corporate supplementary medical insurance) are limited to healthy people.
The insured population is limited, and the product payout is relatively low, about 33%, which affects the entire medical insurance system.
The contribution is limited
.
On the other hand, the boundary between commercial insurance and medical insurance is blurred.
In particular, corporate supplementary insurance and outpatient medical insurance overlap.
About 75% of commercial health insurance does not cover services or medicines other than medical insurance, and there is a lack of long-term medical insurance products
.
From the perspective of guaranteeing the availability of innovative drugs, the popularization of innovative drugs can reduce the social costs caused by diseases.
Under the current situation that medical insurance is the main payer of innovative drugs, the development of payment channels other than medical insurance such as commercial health insurance will help you The sustained and healthy development of the medical insurance system is crucial, but the current commercial insurance contributes a relatively low proportion of drug expenditures, and the coverage is mainly based on the drugs in the medical insurance catalogue
.
In particular, corporate supplementary insurance and outpatient medical insurance overlap.
About 75% of commercial health insurance does not cover services or medicines other than medical insurance, and there is a lack of long-term medical insurance products
.
From the perspective of guaranteeing the availability of innovative drugs, the popularization of innovative drugs can reduce the social costs caused by diseases.
Under the current situation that medical insurance is the main payer of innovative drugs, the development of payment channels other than medical insurance such as commercial health insurance will help you The sustained and healthy development of the medical insurance system is crucial, but the current commercial insurance contributes a relatively low proportion of drug expenditures, and the coverage is mainly based on the drugs in the medical insurance catalogue
.
02 countries learn from experience
Commercial health insurance plays a very important role in many countries around the world
.
From the perspective of demand-level protection, according to the "European Health System and Policy Observation" summary of commercial health insurance in middle and high-income countries, commercial health insurance mainly plays four roles: complementary commercial health insurance and complementary commercial health insurance -Self-paid supplementary and supplementary commercial health insurance-Supplementary and alternative commercial health insurance outside of medical insurance
.
.
From the perspective of demand-level protection, according to the "European Health System and Policy Observation" summary of commercial health insurance in middle and high-income countries, commercial health insurance mainly plays four roles: complementary commercial health insurance and complementary commercial health insurance -Self-paid supplementary and supplementary commercial health insurance-Supplementary and alternative commercial health insurance outside of medical insurance
.
Among the representative countries in the main commercial health insurance market, the main coverage responsibilities of commercial health insurance are different
.
.
Take the United States as an example.
The U.
S.
medical insurance system is dominated by commercial health insurance, covering about 55% of the population (employer insurance accounts for 49% and personal insurance accounts for 6%); followed by government-led Medicare and Medicaid plans.
Covering approximately 17% and 18% of the U.
S.
population respectively; the protection plan for the other 2% of the population is provided by the U.
S.
military; only about 8% of the remaining population does not have a health insurance plan
.
The U.
S.
medical insurance system is dominated by commercial health insurance, covering about 55% of the population (employer insurance accounts for 49% and personal insurance accounts for 6%); followed by government-led Medicare and Medicaid plans.
Covering approximately 17% and 18% of the U.
S.
population respectively; the protection plan for the other 2% of the population is provided by the U.
S.
military; only about 8% of the remaining population does not have a health insurance plan
.
In 2016, the total expenditure on health insurance in the United States was approximately US$2.
4 trillion, of which commercial health insurance expenditure accounted for 48%, Medicare expenditure accounted for 28%, and Medicaid expenditure accounted for 24%
.
Since Medicare insurance in the United States is basically universal coverage, it is similar to social insurance in China
.
There are 5 types of Medicare:
4 trillion, of which commercial health insurance expenditure accounted for 48%, Medicare expenditure accounted for 28%, and Medicaid expenditure accounted for 24%
.
Since Medicare insurance in the United States is basically universal coverage, it is similar to social insurance in China
.
There are 5 types of Medicare:
Throughout the history of the development of commercial health insurance in the United States, corporate group insurance has played an extremely important role
.
After World War II, due to a large labor shortage and high inflation, the United States passed the "1942 Stablization Act" to restrict companies from paying excessively high wages for their employees
.
However, companies are not restricted in purchasing medical benefits for their employees, and at the same time they can be tax-exempt.
This stage promotes the U.
S.
health insurance to an employer-based structure
.
By 1955, the U.
S.
corporate group insurance coverage rate had increased to about 70%, and it was about 10% before World War II
.
.
After World War II, due to a large labor shortage and high inflation, the United States passed the "1942 Stablization Act" to restrict companies from paying excessively high wages for their employees
.
However, companies are not restricted in purchasing medical benefits for their employees, and at the same time they can be tax-exempt.
This stage promotes the U.
S.
health insurance to an employer-based structure
.
By 1955, the U.
S.
corporate group insurance coverage rate had increased to about 70%, and it was about 10% before World War II
.
By the 1960s, the lack of security for vulnerable groups such as the elderly and the disabled gradually aroused widespread public concern.
Therefore, the government intervened to establish Medicare and Medicaid based on social security, and combined social security financing and personal financing to solve the participation of this part of the population.
Guarantee problem
.
Therefore, the government intervened to establish Medicare and Medicaid based on social security, and combined social security financing and personal financing to solve the participation of this part of the population.
Guarantee problem
.
The problem that people with the disease could not be insured was finally resolved in 2010 through government participation
.
In 2010, about 17.
8% of the non-elderly population in the United States still had no medical insurance.
In 2010, the Obama administration promoted the passage of the "Affordable Patient Act", which is the most breakthrough medical insurance bill in the United States since the Medicare and Medicaid plans were enacted in 1965.
.
.
In 2010, about 17.
8% of the non-elderly population in the United States still had no medical insurance.
In 2010, the Obama administration promoted the passage of the "Affordable Patient Act", which is the most breakthrough medical insurance bill in the United States since the Medicare and Medicaid plans were enacted in 1965.
.
All in all, the policies of European and American countries generally reflect the characteristics of "separation of management and operation" in the way of participating in commercial health insurance
.
In terms of "management", the medical security system is generally clearly regulated through legislative means
.
Taking Germany as an example, the "Sickness Social Insurance Law" passed by the parliament at the end of the 18th century is the world's earliest bill related to the medical security system.
It stipulates that all workers engaged in industrial economic activities (except agricultural workers) shall be subject to compulsory sickness social insurance
.
Since then, Germany has successively promulgated more than ten relevant laws, such as the "Employee Insurance Law", "The First Controlling Medical Expenses Law", the " Hospital Medical Expenses Control Law" and the "Medical Insurance Structure Law" at different stages of development
.
Developed countries such as the United Kingdom, France, the Netherlands, the United States, Israel, and Australia also mainly use legislation to provide detailed regulations on the medical security system
.
.
In terms of "management", the medical security system is generally clearly regulated through legislative means
.
Taking Germany as an example, the "Sickness Social Insurance Law" passed by the parliament at the end of the 18th century is the world's earliest bill related to the medical security system.
It stipulates that all workers engaged in industrial economic activities (except agricultural workers) shall be subject to compulsory sickness social insurance
.
Since then, Germany has successively promulgated more than ten relevant laws, such as the "Employee Insurance Law", "The First Controlling Medical Expenses Law", the " Hospital Medical Expenses Control Law" and the "Medical Insurance Structure Law" at different stages of development
.
Developed countries such as the United Kingdom, France, the Netherlands, the United States, Israel, and Australia also mainly use legislation to provide detailed regulations on the medical security system
.
European and American countries have a relatively clear granularity of legislation, and a series of legal regulations are imposed on the population, scope, encouragement and restriction policies of social insurance and commercial health insurance
.
Take Australia as an example.
Its "Private Health Insurance Act 2007" adopts hundreds of detailed regulations, provides and incentives to encourage people to purchase private commercial health insurance, and also stipulates the planning of private health insurance products
.
.
Take Australia as an example.
Its "Private Health Insurance Act 2007" adopts hundreds of detailed regulations, provides and incentives to encourage people to purchase private commercial health insurance, and also stipulates the planning of private health insurance products
.
In terms of "office", the administrative department mainly supervises and enforces legal provisions
.
The regulatory bodies for commercial health insurance are divided into three models: one is the supervision of financial management agencies, such as the French Prudential Regulation and Resolution Agency (ACPR); the other is the establishment of a special commercial health insurance management part in the health sector, such as the Brazilian national private Health Insurance Regulatory Agency (ANS); the third is unified management by the subordinate units of the health department, such as the US Federal Medical Insurance and Medical Assistance Service (CMS)
.
.
The regulatory bodies for commercial health insurance are divided into three models: one is the supervision of financial management agencies, such as the French Prudential Regulation and Resolution Agency (ACPR); the other is the establishment of a special commercial health insurance management part in the health sector, such as the Brazilian national private Health Insurance Regulatory Agency (ANS); the third is unified management by the subordinate units of the health department, such as the US Federal Medical Insurance and Medical Assistance Service (CMS)
.
03Multi -level guarantee policy recommendations
Combining international experience and suggestions from domestic experts, this report puts forward suggestions from four aspects:
At the level of top-level design for perfecting multi-level guarantees
.
First, pass legislation to further clarify the relationship between the various levels of multi-level protection.
First, the payment scope and payment level boundaries of medical insurance should be clarified to clarify the development space for commercial insurance.
Second, commercial health insurance should cover multi-level needs and respond to needs at all levels Clearly defined
.
The second is to clarify the government organization setting of commercial health insurance
.
.
First, pass legislation to further clarify the relationship between the various levels of multi-level protection.
First, the payment scope and payment level boundaries of medical insurance should be clarified to clarify the development space for commercial insurance.
Second, commercial health insurance should cover multi-level needs and respond to needs at all levels Clearly defined
.
The second is to clarify the government organization setting of commercial health insurance
.
In terms of promoting the sustainable development of commercial health insurance, it is recommended that the National Medical Insurance Administration, together with the Ministry of Finance and the China Banking and Insurance Regulatory Commission, actively promote the development of urban inclusive insurance, and local governments should promote the implementation of local urban inclusive insurance
.
For example, Beijing recently launched the Urban Inclusive Insurance
.
At the same time, it is recommended that innovative drugs with high clinical value but not included in the national medical insurance catalogue be used as the "basic supplementary layer"
.
.
For example, Beijing recently launched the Urban Inclusive Insurance
.
At the same time, it is recommended that innovative drugs with high clinical value but not included in the national medical insurance catalogue be used as the "basic supplementary layer"
.
To improve the efficient use of medical insurance funds, improve the dynamic adjustment mechanism of the medical insurance catalog, and establish a value-oriented, scientific, objective, open and transparent medical insurance catalog adjustment mechanism
.
.
In promoting the integration and linkage of medical insurance and commercial insurance, exploration and breakthroughs can be made in the payment of innovative drugs
.
For example, adjust the medical insurance payment standard operating mechanism, while keeping the medical insurance payment standard confidential, allow the actual market price to be higher than the medical insurance payment standard, and encourage the part higher than the payment standard to be included in the scope of commercial health insurance coverage
.
At the same time, explore the payment model of risk sharing
.
.
For example, adjust the medical insurance payment standard operating mechanism, while keeping the medical insurance payment standard confidential, allow the actual market price to be higher than the medical insurance payment standard, and encourage the part higher than the payment standard to be included in the scope of commercial health insurance coverage
.
At the same time, explore the payment model of risk sharing
.
Medical Network, August 25, recently, PhIRDA and RDPAC jointly released the report "Multi-level Medical Security System Boosts People's Health and High-quality Industrial Development".
This report is the third in a series of reports "Building China's Pharmaceutical Innovation Ecosystem".
It aims to start from the current situation and challenges of China's medical security system and innovative drug payment system, and learn from the mature experience of the construction and development of multi-level medical security systems in Germany, the United States, France, Australia and other countries to improve China's multi-level medical security System construction
.
This report is the third in a series of reports "Building China's Pharmaceutical Innovation Ecosystem".
It aims to start from the current situation and challenges of China's medical security system and innovative drug payment system, and learn from the mature experience of the construction and development of multi-level medical security systems in Germany, the United States, France, Australia and other countries to improve China's multi-level medical security System construction
.
This report answers the following three questions through research: First, from the demand level, what needs should be covered by commercial health insurance (including supplementary medical insurance)? Second, from the population level, who should be covered by commercial health insurance? Third, how should the government participate in the construction of multi-level medical security?
01 Current Status of China's Commercial Health Insurance
01 Current Status of China's Commercial Health Insurance As of 2020, China's basic medical insurance system has covered 1.
361 billion people, almost universal coverage, and has developed from a single hospitalization plan to a comprehensive plan for outpatients and hospitalizations.
It has established a protection and assistance system for major and major diseases, and the scope of medication has been further expanded
.
361 billion people, almost universal coverage, and has developed from a single hospitalization plan to a comprehensive plan for outpatients and hospitalizations.
It has established a protection and assistance system for major and major diseases, and the scope of medication has been further expanded
.
However, compared with developed countries, China's per capita expenditure on basic medical insurance is relatively low, which is only about 1/10-1/15 of that of developed countries in Europe
.
Even by 2025, if medical insurance expenditure reaches about 4 trillion yuan, China's per capita medical insurance expenditure will still be significantly lower than that of developed countries
.
.
Even by 2025, if medical insurance expenditure reaches about 4 trillion yuan, China's per capita medical insurance expenditure will still be significantly lower than that of developed countries
.
On the other hand, although the dynamic adjustment of the medical insurance catalogue gradually established since 2017 has been effective and improved the accessibility of innovative drugs, overall, the proportion of innovative drugs in China's drug costs is not high
.
Data shows that in 2018, the cost of patented original research drugs in China only accounted for 9%, while the proportion of European and American countries has reached more than 40%.
The per capita GDP of Turkey, Russia, Mexico, Brazil, Indonesia, South Africa, etc.
is similar to or lower than that of China.
This proportion of the country also exceeds 20%
.
Medicine, medicine, medicine.
Data shows that in 2018, the cost of patented original research drugs in China only accounted for 9%, while the proportion of European and American countries has reached more than 40%.
The per capita GDP of Turkey, Russia, Mexico, Brazil, Indonesia, South Africa, etc.
is similar to or lower than that of China.
This proportion of the country also exceeds 20%
.
For the innovative drug industry that is in the "introduction period" and the early "growth period", a reasonable price level is also needed for protection and incentives
.
However, in recent years, medical insurance has achieved a significant price reduction effect through "soul bargaining".
At the same time, China's drug patents have been maintained for a short period of time.
The growth period of innovative drugs is often short.
There are often premature profits or even losses, and it is difficult for pharmaceutical companies to be effective.
Make up for the R&D cost invested in the early stage
.
.
However, in recent years, medical insurance has achieved a significant price reduction effect through "soul bargaining".
At the same time, China's drug patents have been maintained for a short period of time.
The growth period of innovative drugs is often short.
There are often premature profits or even losses, and it is difficult for pharmaceutical companies to be effective.
Make up for the R&D cost invested in the early stage
.
Therefore, it is imperative to build a multi-level medical security system to meet medical and health needs
.
.
The report predicts that commercial health insurance will become the main growth driver for the "multi-level medical security system
.
" The current commercial health insurance market is showing a huge growth trend: in the past five years, the income of commercial health insurance premiums (including corporate supplementary medical insurance) has jumped from 241.
1 billion yuan in 2015 to 706.
6 billion yuan in 2019, an annual increase The speed is as high as 31%
.
Enterprise business enterprise.
" The current commercial health insurance market is showing a huge growth trend: in the past five years, the income of commercial health insurance premiums (including corporate supplementary medical insurance) has jumped from 241.
1 billion yuan in 2015 to 706.
6 billion yuan in 2019, an annual increase The speed is as high as 31%
.
At the same time, the government also attaches great importance to promoting the development of commercial health insurance
.
At the beginning of 2020, the "Opinions on Promoting the Development of Commercial Insurance in Social Services" jointly issued by 13 departments including the China Banking and Insurance Regulatory Commission clearly stated the goal of striving to exceed 2 trillion yuan in commercial health insurance premiums by 2025
.
The report predicts that in the future, commercial health insurance can provide a source of 18% of the total health expenses and become a major contributor to medical insurance
.
.
At the beginning of 2020, the "Opinions on Promoting the Development of Commercial Insurance in Social Services" jointly issued by 13 departments including the China Banking and Insurance Regulatory Commission clearly stated the goal of striving to exceed 2 trillion yuan in commercial health insurance premiums by 2025
.
The report predicts that in the future, commercial health insurance can provide a source of 18% of the total health expenses and become a major contributor to medical insurance
.
However, the analysis of the report shows that the overall protection level of China's commercial health insurance is not high and the boundaries of responsibility are not clear.
It is difficult for high-risk and sick people to participate in insurance.
The sustainability of the development of urban inclusive insurance, which has received widespread attention, still needs time to test
.
In terms of actual insurance participation, only about 40% of the individual insurance premiums (including corporate supplementary medical insurance) are limited to healthy people.
The insured population is limited, and the product payout is relatively low, about 33%, which affects the entire medical insurance system.
The contribution is limited
.
It is difficult for high-risk and sick people to participate in insurance.
The sustainability of the development of urban inclusive insurance, which has received widespread attention, still needs time to test
.
In terms of actual insurance participation, only about 40% of the individual insurance premiums (including corporate supplementary medical insurance) are limited to healthy people.
The insured population is limited, and the product payout is relatively low, about 33%, which affects the entire medical insurance system.
The contribution is limited
.
On the other hand, the boundary between commercial insurance and medical insurance is blurred.
In particular, corporate supplementary insurance and outpatient medical insurance overlap.
About 75% of commercial health insurance does not cover services or medicines other than medical insurance, and there is a lack of long-term medical insurance products
.
From the perspective of guaranteeing the availability of innovative drugs, the popularization of innovative drugs can reduce the social costs caused by diseases.
Under the current situation that medical insurance is the main payer of innovative drugs, the development of payment channels other than medical insurance such as commercial health insurance will help you The sustained and healthy development of the medical insurance system is crucial, but the current commercial insurance contributes a relatively low proportion of drug expenditures, and the coverage is mainly based on the drugs in the medical insurance catalogue
.
In particular, corporate supplementary insurance and outpatient medical insurance overlap.
About 75% of commercial health insurance does not cover services or medicines other than medical insurance, and there is a lack of long-term medical insurance products
.
From the perspective of guaranteeing the availability of innovative drugs, the popularization of innovative drugs can reduce the social costs caused by diseases.
Under the current situation that medical insurance is the main payer of innovative drugs, the development of payment channels other than medical insurance such as commercial health insurance will help you The sustained and healthy development of the medical insurance system is crucial, but the current commercial insurance contributes a relatively low proportion of drug expenditures, and the coverage is mainly based on the drugs in the medical insurance catalogue
.
02 countries learn from experience
02 countries learn from experience Commercial health insurance plays a very important role in many countries around the world
.
From the perspective of demand-level protection, according to the "European Health System and Policy Observation" summary of commercial health insurance in middle and high-income countries, commercial health insurance mainly plays four roles: complementary commercial health insurance and complementary commercial health insurance -Self-paid supplementary and supplementary commercial health insurance-Supplementary and alternative commercial health insurance outside of medical insurance
.
.
From the perspective of demand-level protection, according to the "European Health System and Policy Observation" summary of commercial health insurance in middle and high-income countries, commercial health insurance mainly plays four roles: complementary commercial health insurance and complementary commercial health insurance -Self-paid supplementary and supplementary commercial health insurance-Supplementary and alternative commercial health insurance outside of medical insurance
.
Among the representative countries in the main commercial health insurance market, the main coverage responsibilities of commercial health insurance are different
.
.
Take the United States as an example.
The U.
S.
medical insurance system is dominated by commercial health insurance, covering about 55% of the population (employer insurance accounts for 49% and personal insurance accounts for 6%); followed by government-led Medicare and Medicaid plans.
Covering approximately 17% and 18% of the U.
S.
population respectively; the protection plan for the other 2% of the population is provided by the U.
S.
military; only about 8% of the remaining population does not have a health insurance plan
.
The U.
S.
medical insurance system is dominated by commercial health insurance, covering about 55% of the population (employer insurance accounts for 49% and personal insurance accounts for 6%); followed by government-led Medicare and Medicaid plans.
Covering approximately 17% and 18% of the U.
S.
population respectively; the protection plan for the other 2% of the population is provided by the U.
S.
military; only about 8% of the remaining population does not have a health insurance plan
.
In 2016, the total expenditure on health insurance in the United States was approximately US$2.
4 trillion, of which commercial health insurance expenditure accounted for 48%, Medicare expenditure accounted for 28%, and Medicaid expenditure accounted for 24%
.
Since Medicare insurance in the United States is basically universal coverage, it is similar to social insurance in China
.
There are 5 types of Medicare:
4 trillion, of which commercial health insurance expenditure accounted for 48%, Medicare expenditure accounted for 28%, and Medicaid expenditure accounted for 24%
.
Since Medicare insurance in the United States is basically universal coverage, it is similar to social insurance in China
.
There are 5 types of Medicare:
Throughout the history of the development of commercial health insurance in the United States, corporate group insurance has played an extremely important role
.
After World War II, due to a large labor shortage and high inflation, the United States passed the "1942 Stablization Act" to restrict companies from paying excessively high wages for their employees
.
However, companies are not restricted in purchasing medical benefits for their employees, and at the same time they can be tax-exempt.
This stage promotes the U.
S.
health insurance to an employer-based structure
.
By 1955, the U.
S.
corporate group insurance coverage rate had increased to about 70%, and it was about 10% before World War II
.
.
After World War II, due to a large labor shortage and high inflation, the United States passed the "1942 Stablization Act" to restrict companies from paying excessively high wages for their employees
.
However, companies are not restricted in purchasing medical benefits for their employees, and at the same time they can be tax-exempt.
This stage promotes the U.
S.
health insurance to an employer-based structure
.
By 1955, the U.
S.
corporate group insurance coverage rate had increased to about 70%, and it was about 10% before World War II
.
By the 1960s, the lack of security for vulnerable groups such as the elderly and the disabled gradually aroused widespread public concern.
Therefore, the government intervened to establish Medicare and Medicaid based on social security, and combined social security financing and personal financing to solve the participation of this part of the population.
Guarantee problem
.
Therefore, the government intervened to establish Medicare and Medicaid based on social security, and combined social security financing and personal financing to solve the participation of this part of the population.
Guarantee problem
.
The problem that people with the disease could not be insured was finally resolved in 2010 through government participation
.
In 2010, about 17.
8% of the non-elderly population in the United States still had no medical insurance.
In 2010, the Obama administration promoted the passage of the "Affordable Patient Act", which is the most breakthrough medical insurance bill in the United States since the Medicare and Medicaid plans were enacted in 1965.
.
.
In 2010, about 17.
8% of the non-elderly population in the United States still had no medical insurance.
In 2010, the Obama administration promoted the passage of the "Affordable Patient Act", which is the most breakthrough medical insurance bill in the United States since the Medicare and Medicaid plans were enacted in 1965.
.
All in all, the policies of European and American countries generally reflect the characteristics of "separation of management and operation" in the way of participating in commercial health insurance
.
In terms of "management", the medical security system is generally clearly regulated through legislative means
.
Taking Germany as an example, the "Sickness Social Insurance Law" passed by the parliament at the end of the 18th century is the world's earliest bill related to the medical security system.
It stipulates that all workers engaged in industrial economic activities (except agricultural workers) shall be subject to compulsory sickness social insurance
.
Since then, Germany has successively promulgated more than ten relevant laws, such as the "Employee Insurance Law", "The First Controlling Medical Expenses Law", the " Hospital Medical Expenses Control Law" and the "Medical Insurance Structure Law" at different stages of development
.
Developed countries such as the United Kingdom, France, the Netherlands, the United States, Israel, and Australia also mainly use legislation to provide detailed regulations on the medical security system
.
Hospital hospital hospital.
In terms of "management", the medical security system is generally clearly regulated through legislative means
.
Taking Germany as an example, the "Sickness Social Insurance Law" passed by the parliament at the end of the 18th century is the world's earliest bill related to the medical security system.
It stipulates that all workers engaged in industrial economic activities (except agricultural workers) shall be subject to compulsory sickness social insurance
.
Since then, Germany has successively promulgated more than ten relevant laws, such as the "Employee Insurance Law", "The First Controlling Medical Expenses Law", the " Hospital Medical Expenses Control Law" and the "Medical Insurance Structure Law" at different stages of development
.
Developed countries such as the United Kingdom, France, the Netherlands, the United States, Israel, and Australia also mainly use legislation to provide detailed regulations on the medical security system
.
European and American countries have a relatively clear granularity of legislation, and a series of legal regulations are imposed on the population, scope, encouragement and restriction policies of social insurance and commercial health insurance
.
Take Australia as an example.
Its "Private Health Insurance Act 2007" adopts hundreds of detailed regulations, provides and incentives to encourage people to purchase private commercial health insurance, and also stipulates the planning of private health insurance products
.
Healthy, healthy, healthy.
Take Australia as an example.
Its "Private Health Insurance Act 2007" adopts hundreds of detailed regulations, provides and incentives to encourage people to purchase private commercial health insurance, and also stipulates the planning of private health insurance products
.
In terms of "office", the administrative department mainly supervises and enforces legal provisions
.
The regulatory bodies for commercial health insurance are divided into three models: one is the supervision of financial management agencies, such as the French Prudential Regulation and Resolution Agency (ACPR); the other is the establishment of a special commercial health insurance management part in the health sector, such as the Brazilian national private Health Insurance Regulatory Agency (ANS); the third is unified management by the subordinate units of the health department, such as the US Federal Medical Insurance and Medical Assistance Service (CMS)
.
.
The regulatory bodies for commercial health insurance are divided into three models: one is the supervision of financial management agencies, such as the French Prudential Regulation and Resolution Agency (ACPR); the other is the establishment of a special commercial health insurance management part in the health sector, such as the Brazilian national private Health Insurance Regulatory Agency (ANS); the third is unified management by the subordinate units of the health department, such as the US Federal Medical Insurance and Medical Assistance Service (CMS)
.
03Multi -level guarantee policy recommendations
03Multi -level guarantee policy recommendations Combining international experience and suggestions from domestic experts, this report puts forward suggestions from four aspects:
At the level of top-level design for perfecting multi-level guarantees
.
First, pass legislation to further clarify the relationship between the various levels of multi-level protection.
First, the payment scope and payment level boundaries of medical insurance should be clarified to clarify the development space for commercial insurance.
Second, commercial health insurance should cover multi-level needs and respond to needs at all levels Clearly defined
.
The second is to clarify the government organization setting of commercial health insurance
.
.
First, pass legislation to further clarify the relationship between the various levels of multi-level protection.
First, the payment scope and payment level boundaries of medical insurance should be clarified to clarify the development space for commercial insurance.
Second, commercial health insurance should cover multi-level needs and respond to needs at all levels Clearly defined
.
The second is to clarify the government organization setting of commercial health insurance
.
In terms of promoting the sustainable development of commercial health insurance, it is recommended that the National Medical Insurance Administration, together with the Ministry of Finance and the China Banking and Insurance Regulatory Commission, actively promote the development of urban inclusive insurance, and local governments should promote the implementation of local urban inclusive insurance
.
For example, Beijing recently launched the Urban Inclusive Insurance
.
At the same time, it is recommended that innovative drugs with high clinical value but not included in the national medical insurance catalogue be used as the "basic supplementary layer"
.
.
For example, Beijing recently launched the Urban Inclusive Insurance
.
At the same time, it is recommended that innovative drugs with high clinical value but not included in the national medical insurance catalogue be used as the "basic supplementary layer"
.
To improve the efficient use of medical insurance funds, improve the dynamic adjustment mechanism of the medical insurance catalog, and establish a value-oriented, scientific, objective, open and transparent medical insurance catalog adjustment mechanism
.
.
In promoting the integration and linkage of medical insurance and commercial insurance, exploration and breakthroughs can be made in the payment of innovative drugs
.
For example, adjust the medical insurance payment standard operating mechanism, while keeping the medical insurance payment standard confidential, allow the actual market price to be higher than the medical insurance payment standard, and encourage the part higher than the payment standard to be included in the scope of commercial health insurance coverage
.
At the same time, explore the payment model of risk sharing
.
Standard Standard Standard .
For example, adjust the medical insurance payment standard operating mechanism, while keeping the medical insurance payment standard confidential, allow the actual market price to be higher than the medical insurance payment standard, and encourage the part higher than the payment standard to be included in the scope of commercial health insurance coverage
.
At the same time, explore the payment model of risk sharing
.
