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国家医保局回应每经:“十四五”期间跨省异地就医直接结算服务超5亿人次,减少群众垫付超5500亿元
Mei Ri Jing Ji Xin Wen·2025-07-24 08:26

Core Insights - The "14th Five-Year Plan" period has seen significant advancements in China's medical insurance reform, particularly in cross-provincial medical treatment and direct settlement services, with the number of direct settlements increasing from 5.37 million in 2020 to 238 million by 2024, representing a growth of over 40 times [1] - The establishment of a nationwide unified medical insurance information platform has facilitated the use of medical insurance codes for over 1.2 billion people, enhancing the efficiency and accessibility of medical services [2] Group 1: Cross-Provincial Medical Insurance - The number of cross-provincial direct settlement services has exceeded 500 million, reducing out-of-pocket expenses for citizens by over 550 billion yuan, with a direct settlement rate for cross-provincial hospitalizations reaching approximately 90% [3] - The scope of direct settlements has expanded from hospitalizations to include outpatient services for chronic diseases, benefiting more insured individuals [1] Group 2: Medical Insurance Information Platform - The national medical insurance information platform has achieved millisecond-level response times, with daily settlements exceeding 14.5 million transactions [3] - The online handling rate for medical insurance government services has increased from 55% in 2020 to 92% by 2024, indicating a significant improvement in service accessibility [2] Group 3: Drug Price Management - The National Medical Insurance Administration has urged 566 companies to adjust the prices of 726 drug specifications, addressing issues of excessive pricing and market disruption caused by companies abusing their pricing autonomy [4][5] - The 11th batch of centralized procurement has been initiated, focusing on maintaining clinical stability, ensuring quality, and preventing market manipulation [5]