促进医疗医保医药协同发展和治理

Core Viewpoint - Since the 18th National Congress of the Communist Party of China, the country has been committed to deepening medical security reform, enhancing the management and service level of medical insurance, and promoting the coordinated development and governance of the "three medicines" (medical care, medical insurance, and pharmaceuticals) [1] Group 1: Achievements and Challenges - Significant achievements have been made in promoting the coordinated development and governance of the "three medicines," but challenges remain in the process of high-quality development [2] - The contradiction between limited medical insurance funding and the rapid growth of medical expenses has become prominent, with medical expenses increasing due to rising demand for medical services and advancements in clinical diagnosis and treatment technologies [2] - The reimbursement rates for inpatient care under employee and resident medical insurance remain stable at around 85% and 70%, respectively, but there is insufficient funding support for increasing outpatient reimbursement rates for residents [2] Group 2: Future Directions - The goal of health performance is to deepen the reform of the medical and health system and promote the coordinated development and governance of the "three medicines" [2] - Recommendations include scientifically formulating regional health planning to improve resource allocation efficiency, enhancing the construction of the medical and health service system, and ensuring that medical resources are allocated based on the needs of the population [3] - The establishment of county-level medical communities is emphasized to strengthen the foundation of basic medical services, integrating responsibilities, management, services, and benefits [4] Group 3: Reforms and System Improvements - Key reforms in the medical insurance sector should focus on optimizing benefit policies, adjusting medical catalogs, and enhancing price reforms and fund supervision [4] - A multi-level medical security system should be established, promoting the development of commercial health insurance alongside basic medical insurance to meet diverse medical service needs [5] - The aim is to ensure the safety and effectiveness of medical insurance funds, improve the quality and efficiency of medical services, and support the innovation and development of the pharmaceutical industry [5]