Shanghai has unveiled 18 new measures to expand healthcare access, aiming to strengthen commercial health insurance and accelerate the adoption of innovative pharmaceuticals and medical devices across the city, authorities announced on Aug 6.

The initiative, launched jointly by seven municipal bodies including the Shanghai Financial Regulatory Bureau, seeks to ease patients' financial burdens and build a more robust medical security system in Shanghai.

At the core of the new regulations is a strategy to better coordinate basic medical insurance with commercial health insurance. City officials plan to integrate cutting-edge drugs and medical equipment into commercial insurance plans.

A representative from the Shanghai Municipal Medical Insurance Bureau emphasized that the primary objective is "to enhance coordination between basic and commercial insurance and to foster innovation in the commercial health insurance and biomedical sectors".

The measures support expanded coverage of "Huhuibao", Shanghai's supplementary medical insurance, to include innovative pharmaceuticals and medical devices.

There will also be encouragement for the development of tailored "Hu" series health insurance products designed to meet the needs of different demographic groups.

Streamlining insurance claims is a key focus. The city plans to simplify the "direct billing" system, allowing patients to settle expenses directly through their commercial insurance at a wider range of hospitals, encompassing all secondary and tertiary facilities, as well as specialty and international departments. This "one-stop" settlement process aims to reduce out-of-pocket costs and simplify claims for residents.

The policy specifically targets easing insurance restrictions for the elderly, children, and individuals with pre-existing conditions.

Insurers are encouraged to adopt data-driven pricing models to expand affordable commercial health coverage for vulnerable populations.

To promote the use of advanced medications and medical devices, Shanghai advocates a multi-payer model involving basic medical insurance, commercial insurance, charitable organizations, and pharmaceutical companies. Hospitals will be encouraged to prescribe innovative drugs covered by basic medical insurance.

To boost efficiency and transparency, Shanghai will leverage data sharing and the "Shanghai Insurance Code" platform. This platform will facilitate product matching, claims settlements, and information dissemination, enhancing "one-code-for-all-claims" functionality through blockchain technology.

Source: Shanghai Observer