发挥商业健康保险功能作用,支持创新医药高质量发展OA

The"15th Five-Year Plan"period marks a critical stage for the high-quality development of China's multi-level medical security system.Against the backdrop of accelerating pharmaceutical innovation,the widespread clinical adoption of high-value innovative drugs and medical devices has significantly enhanced diagnostic and therapeutic outcomes,while also driving up medical expenditure.Anchored in its core function of"covering basic medical needs",China's basic medical insurance(BMI)is unable to fully bridge the cost gap for high-value innovative drugs and medical devices not listed in the national basic medical insurance,work injury insurance and maternity insurance drug catalog or the medical consumables catalog.As a result,the supplementary security role of commercial health insurance(CHI)has become increasingly prominent.In line with relevant national and local policy orientations,this paper examines the policy opportunities and practical bottlenecks for the coordinated development of BMI and CHI from the perspective of insurance institutions.Focusing on three core directions—medical data sharing for BMI,the development of insurance products for innovative drugs and medical devices,and one-stop integrated settlement services for BMI and CHI—it puts forward concrete implementation pathways:establishing a long-term,tiered and categorized data sharing system;developing tiered,diversified insurance products covering innovative drugs and medical devices;and rolling out all-scenario one-stop integrated settlement services across all regions.Meanwhile,taking stroke as a clinical application scenario,this paper explores an operational model for CHI to support the growth of the innovative pharmaceutical sector.This work provides practical references for advancing in-depth coordination between BMI and CHI,improving the clinical accessibility of innovative drugs and medical devices,and strengthening the multi-level medical security system.