Shanghai has introduced 18 measures across five key areas to promote the high-quality development of commercial health insurance and support innovation in the biopharmaceutical industry.
The measures aim to expand the coverage of commercial health insurance, diversify product offerings, accelerate the development of commercial nursing insurance, and build a multi-tiered commercial health insurance system.
Shanghai encourages the development of health insurance products tailored to specific groups, such as the elderly, children, and individuals with pre-existing conditions, to enhance their coverage. Insurers are also supported in participating in medical practice standardization and improving health management services to mitigate risks.
Additionally, the city encourages the creation of group health insurance products where employers contribute to premiums, covering innovative medical devices and drugs while enabling synchronized settlement with basic medical insurance. Focused on key economic and social development areas, Shanghai will explore group insurance models, establish risk adjustment mechanisms for innovation, and strengthen risk control safeguards. A “regulatory sandbox” pilot mechanism will also be tested to enhance monitoring and analysis.
Shanghai will improve data sharing between healthcare, medical insurance, and commercial insurance sectors. Data on diseases and indications suitable for innovative medical devices, as well as clinical trial results, will serve as pricing references for insurers. The city will also support integrated settlement services and the development of the “Shanghai Insurance Code” digital platform.
Furthermore, Shanghai will innovate payment mechanisms for advanced medical technologies, facilitating their adoption in hospitals, insurance catalogs, and prescriptions. Medical institutions will be supported in appropriately using innovative devices and drugs, with cases involving insured treatments exempt from disease-based payment limits. Tax incentives and optimized financing methods will also be introduced to boost commercial health insurance. Public awareness campaigns will reinforce policy coordination.
These measures are expected to unlock the growth potential of the commercial health insurance market, positioning it as a key pillar of public health security and a major contributor to diversified payment systems for innovative medical technologies, ensuring comprehensive and accessible healthcare coverage.
