Challenges and Optimization of Dual-Catalogue Governance for Basic Medical and Commercial Health Insurance:An SFIC-Based Analysisn

Corresponding author: WU Fang, xiaoyll@126.com

DOI: 10.12201/bmr.202610.00060

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  Abstract: Objective: To identify challenges in collaborative governance of the dual drug catalogues for basic medical and commercial health insurance and explore strategies for diversified financing of innovative drugs and a multi-tiered medical security system. Methods: Relevant policy documents, official publications, industry reports, academic literature, and local practice materials were collected. Literature review and policy text analysis were conducted using the modified SFIC model as the theoretical framework. Results: Although some progress has been made in the collaborative governance of the dual catalogues, challenges remain in five dimensions: external environment, starting conditions, facilitative leadership, institutional design, and collaborative process. These challenges are reflected in insufficient commercial health insurance market support, imbalanced data and information allocation, inadequate institutionalized coordination mechanisms, incomplete catalogue linkage rules, and poor coordination across the drug access, use, payment, and reimbursement processes. Conclusions: Guided by healthcare–pharmaceutical–insurance integration, mechanisms for secure data sharing, differentiated implementation, price transmission, and catalogue conversion responsibility should be strengthened to advance the dual catalogues from formal linkage to substantive coordination.

  Key words: Commercial health insurance; Basic medical insurance; SFIC model; Collaborative governance

  Submit time: 27 October 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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