保障人民健康 助力经济社会发展——国家医疗保障局介绍“十四五”时期医保工作情况

Core Viewpoint - The "14th Five-Year Plan" emphasizes high-quality development in medical insurance, aiming to enhance public health and support economic growth through comprehensive reforms in the healthcare system [1] Group 1: Medical Insurance Coverage and Reform - During the "14th Five-Year Plan," the basic medical insurance coverage rate is maintained at around 95%, with the number of insured individuals expected to reach 1.327 billion by 2024 [1] - The medical insurance information platform has been fully established, with cross-provincial direct settlement of medical expenses increasing from 5.37 million in 2020 to 23.8 million in 2024, a growth of 44 times [1] - Legislative efforts are ongoing to strengthen the supervision and management of medical insurance funds, with new regulations being implemented [1] Group 2: Payment System Reform - The medical insurance payment system has shifted from "post-payment" to "pre-payment," with over 170 billion yuan pre-paid to medical institutions in 2024 [3] - The settlement cycle has been reduced from 30 working days to no more than 20, with some areas achieving next-day settlements [3] - The annual clearing of medical insurance funds has been expedited, completing six months earlier than at the beginning of the "14th Five-Year Plan" [3] Group 3: Pricing and Service Quality - The National Medical Insurance Administration has introduced pricing guidelines for various medical services, aiming for consistent pricing and comparability across hospitals [4][5] - New pricing projects have been established to encourage high-quality services, such as bedside ultrasound and early infant care [5] - The administration is focusing on industry standards to promote a more regulated and transparent medical market [5] Group 4: Drug Price Management and Innovation - The administration supports pharmaceutical innovation by allowing market-driven pricing for most drugs, with government guidance only for specific categories [6][7] - Since 2018, 10 batches of centralized drug procurement have been conducted, covering 435 types of drugs, which has helped reduce drug prices and improve accessibility [7] - A special governance initiative for drug prices has been launched to standardize pricing for over 27,000 drug specifications [8] Group 5: Reform and Global Cooperation - The medical insurance system promotes both reform and openness, with ongoing efforts to implement successful healthcare models from various regions [9][10] - The administration aims to expand insurance coverage and enhance public awareness through improved mechanisms and digital empowerment [10]