摘要
当前,我国生物医药产业处于从“仿制跟跑”向“创新领跑”跃迁的关键时期,创新是产业转型的原动力。我国已出台多项利好政策,打造多层次医疗保障体系,提升创新药支付能力,加速创新药企回笼资金,助力产业转型。然而,现有制度保障体系仍以基本医保为主要支付主体,商业健康保险保障能力薄弱,难以为创新发展提供可持续资金投入。因此,本文提出发展专业化、规模化的商业健康保险企业,开发“高保费、高品质、高赔付、长期限”的新型商保产品,系统性优化商保政策环境,旨在大力发展商业健康保险,构建创新药的多层次保障新生态,为激发我国生物医药产业创新活力提供系统性支持方案。
Abstract
China's biomedical industry is currently at a critical juncture, transitioning from "following generics" to "leading innovation". Innovation is the driving force behind this transformation. China has introduced a number of favorable policies to establish a multi-tier healthcare security system, improve payment capacity for innovative drugs, accelerate capital recovery for innovative pharmaceutical companies, and support transformation of the industry. However, the existing security system still relies primarily on basic medical insurance while commercial health insurance is weak, making it difficult to provide sustainable funding for innovative research and development. Therefore, this paper proposes developing specialized and large-scale commercial health insurance enterprises, creating new commercial health insurance products characterized by "high premiums, high quality, high indemnity, and long-term coverage", and systematically optimizing the commercial health insurance policy environment, in order to vigorously develop commercial health insurance, construct a new ecosystem of multi-tier security system for innovative drugs, and provide systematic support to stimulate innovation vitality in China's biomedical industry.
关键词
多层次保障 /
商业健康保险 /
创新药 /
生物医药产业
Key words
multi-tier security /
commercial health insurance /
innovative drugs /
biomedical industry
丁锦希, 孟凡月, 王锐, 李佳明.
大力发展商业健康险多元支持生物医药创新[J]. 中国医疗保险. 2025, 0(8): 31-38 https://doi.org/10.19546/j.issn.1674-3830.2025.8.004
Developing Commercial Health Insurance Vigorously and Supporting Biomedical Innovation Diversely[J]. China Health Insurance. 2025, 0(8): 31-38 https://doi.org/10.19546/j.issn.1674-3830.2025.8.004
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 药智.同比增长31%！2024年中国上市创新药解析[EB/OL].(2025-07-31)[2025-08-02].https://www.sohu.com/a/919397272_749427.
[2] 摩熵咨询. 2024年中国医疗健康投融资全景洞察报告[R].成都:摩熵咨询,2024.
[3] 国家统计局.全国规模以上工业企业利润(2014年—2024年)[EB/OL].(2025-01-27)[2025-08-03].https://stats.gov.cn/sj/zxfb/202501/t20250127_1958485.html.
[4] PhRMA.2024 PhRMA Membership Annual Survey[EB/OL].(2025-07-13)[2025-08-03].https://phrma.org/resources/2024-phrma-annual-membership-survey.
[5] 中再寿险,镁信健康,波士顿咨询公司.中国创新药械多元支付白皮书(2025)[R].北京:中再寿险,2025.
[6] 国家医疗保障局. 2024年全国医疗保障事业发展统计公报[EB/OL].(2025-07-14)[2025-08-03].https://www.gov.cn/lianbo/bumen/202507/content_7031956.htm.
[7] 易联招采网.基于药易云商保板块的惠民保市场数据分析报告[EB/OL].(2024-11-28)[2025-08-03].https://xueqiu.com/8608328401/310313954.
[8] 清华大学药品监管科学研究院,医药魔方.全球视野下的中国创新药产业:十年回顾与展望(2015-2024)[R].北京:清华大学药品监管科学研究院,2025.
[9] U.S. Department of Justice. Award Terms and Conditions for Office for Victims of Crime Grants: Standard Grant Agreement Template[Z/OL]. (2025-04-07)[2025-07-31]. https://ojp.gov/funding/Part200UniformRequirements.htm.
[10] Peoplekeep.Top 25 health insurance companies in the US[EB/OL].(2025-01-09)[2025-07-31].https://www.peoplekeep.com/blog/top-25-health-insurance-companies-in-the-u.s.
[11] 南开大学卫生经济与医疗保障研究中心.惠民保发展模式研究报告2024[R].天津:南开大学卫生经济与医疗保障研究中心,2024.
[12] 财政部,税务总局,保监会.关于将商业健康保险个人所得税试点政策推广到全国范围实施的通知[EB/OL].(2017-04-28)[2025-07-19].https://guangdong.chinatax.gov.cn/gdsw/zjfg/2017-05/03/content_f7a7387e2ba441a995345e7c0d60e44f.shtml.
[13] 北京市人民政府. 2023年度个税汇算清缴数据发布——无需纳税人员占比超七成[EB/OL].(2024-10-16)[2025-08-02].https://www.beijing.gov.cn/ywdt/zybwdt/202410/t20241016_3921536.html.
[14] PrivateHealth.gov.au. Australian Government Private Health Insurance Rebate[EB/OL].(2024-06-15)[2025-07-18].https://privatehealth.gov.au/health_insurance/surcharges_incentives/insurance_rebate.htm.
[15] CMS. 2025 Medicare Advantage and Part D Star Ratings[EB/OL].(2024-10-15)[2024-11-01].http://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-star-ratings.
[16] 国家医保局.医保商保一体化同步结算平台已经开始上线运行[EB/OL].(2025-01-29)[2025-08-02].https://www.nhsa.gov.cn/art/2025/1/29/art_14_15596.html.
