▶️Frontline Perspectives: Realities and the Road Ahead for Commercial Health Insurance in China
Commercial health insurance still represents a small share of China’s total health spending today—but by 2035, it could account for as much as 44% of spending on innovative drugs and devices. Achieving that potential will require sustained innovation in product design, risk management, and integration with other parts of the healthcare system.
In this C-List Masterclass PBM CEO panel, two leading commercial insurance executives shared candid perspectives from the front lines—what’s working, where integration is stalling, and if China’s new commercial innovative drug list could accelerate insurance innovation.
Topics covered in the discussion:
- Short-Term vs. Long-Term Medical Insurance – Why regulatory progress hasn’t yet unlocked scale for long-term plans.
- Group Health Insurance – Employer interest in enhanced outpatient and specialty pharmacy benefits, and the operational hurdles to making them viable.
- Chronic Disease Management – How older foreign brands are using insurer partnerships to pair financial protection with value-added services—and whether it’s sustainable.
- Chronic Disease Management (2.0) – Shifting from single-disease, single-drug products to multi-disease, multi-drug, multi-layered approaches, and their impact on enrollment, adherence, and sustainability.
- BMI–Commercial Data Sharing – The technical, legal, and institutional gaps that still limit effective collaboration despite favorable policy signals.
- Online Distribution Integration – The distinct roles of O2O and B2C channels, and where insurance innovation can strengthen China’s fast-evolving eCommerce drug distribution market.
- Private Hospital Integration – Progress and persistent barriers to aligning commercial insurance with private care, and the one capability insurers must develop to succeed.
Diverse, Real-World Perspectives
What stood out most: The discussion brought diverse viewpoints from panelists and Kelly—each shaped by individual experience and, for the panelists, closely tied to the realities of China’s commercial health insurance landscape. Together, they offered grounded, real-world insights into market opportunities, constraints, and potential innovation paths.
Panelists:
Dr. Gong Gang
- Chairman of Huibao Fuda Health Technology, a leading digital health and PBM firm
- Former senior executive at Taikang and Sunshine Life
- National policy advisor to the former China Insurance Regulatory Commission
Ma Jie
- Founder & CEO of Oak Health, China’s leading PBM with a nationwide specialty pharmacy network
- Leads initiatives with top pharma and insurers to pioneer payment models that make treatment affordable for patients with pre-existing conditions
Kelly Ke (Moderator)
- Award-winning former Senior Advisor, Deloitte US Life Sciences Practice
- Founder, bizi LLC, an access intelligence consultancy
- Author, NRDL+ Executive Debrief—a widely followed China market access newsletter for global life sciences leaders
