4年200亿人次报销，未来五年全民医保如何升级｜“十四五”规划收官

Group 1 - The core viewpoint emphasizes the dual role of medical insurance in promoting common prosperity and providing institutional support for the development of new productive forces during the "15th Five-Year Plan" period [1][9] - The national medical insurance coverage reached 1.327 billion people, with a stable basic medical insurance participation rate of around 95% during the "14th Five-Year Plan" period, benefiting nearly 20 billion medical reimbursements [2][9] - The government aims to balance fairness and efficiency in medical insurance development, adapting to high-quality development needs through institutional innovation [1][2] Group 2 - The per capita financial subsidy for residents' insurance contributions increased from 490 yuan in 2018 to 670 yuan in 2024, with rural low-income and poverty alleviation populations maintaining a participation rate of over 99% [2] - The total medical insurance expenditure reached 12.13 trillion yuan during the "14th Five-Year Plan," with an average annual growth rate of 9.1% [9] - The medical insurance fund's expenditure on newly negotiated drugs increased significantly, with 2024 spending being 3.9 times that of 2020, reflecting a 40% annual growth rate [9] Group 3 - The number of designated medical institutions for medical insurance is expected to reach 1.1 million by June 2025, with cross-provincial direct settlement for outpatient chronic diseases expanding to 10 types [3] - Approximately 200 million urban employees are still not covered by basic medical insurance, highlighting a gap in coverage for flexible employment [3][4] - Local medical insurance bureaus are exploring pathways for new employment forms to participate in basic medical insurance, with various strategies being implemented [4] Group 4 - The medical insurance fund's total expenses for employees and residents are projected to grow at a slower rate, with 2024 medical expenses for employee insurance at approximately 2.06 trillion yuan, a 3.6% increase from the previous year [7] - The implementation of a multi-tiered payment system for major diseases is necessary to reduce the high personal payment ratio, which can lead to financial hardship for families [8] - The focus on long-term care insurance is expected to stabilize funding for related industries, with over 50% growth in service institutions and personnel during the "14th Five-Year Plan" [11]