Meeting the Multilevel Health Insurance Needs of Citizens
Shanghai has recently introduced the “Several Measures to Promote High-Quality Development of Commercial Health Insurance and Support Biopharmaceutical Industry Innovation,” comprising 18 provisions across five key areas. The measures aim to enhance insurance services for public welfare, foster the joint development of commercial insurance and medical insurance, improve the accessibility and affordability of innovative drugs and medical devices, and meet the diverse health insurance needs of citizens.
The measures propose deepening innovation in payment mechanisms for innovative drugs and medical devices, facilitating their entry into hospitals, medical directories, and prescriptions. Cases involving innovative drugs covered by relevant commercial health insurance may be excluded from disease-based payment systems. Additionally, insurers are encouraged to use disease and indication data related to innovative drugs and medical devices, as well as clinical trial results, for pricing reference.
Notably, the measures will enhance the functionality of the “Shanghai Insurance Code,” further optimizing the synchronized settlement model between medical insurance and commercial insurance. The direct claims process will be streamlined, and an automated claims system linking medical and commercial insurance will be established. This will improve data interoperability between healthcare, medical insurance, and commercial insurance, achieving “one-code claims.”
The implementation of these measures will further establish commercial health insurance as a key pillar of the public health security system, providing more comprehensive, diverse, and convenient health coverage.
