我国将全面推进医保基金即时结算

Core Points - The National Healthcare Security Administration (NHSA) aims to alleviate the financial burden on medical institutions by implementing real-time settlement across all coordinated areas by the end of 2025 [1] - By the end of 2026, it is expected that real-time settlement funds will account for over 80% of the monthly settlement funds of local healthcare insurance funds [1] - The initiative will cover various medical expenses, including outpatient services, chronic disease treatments, hospitalizations, maternity care, and pharmacy purchases, with plans to gradually include cross-regional medical expenses [1] Group 1 - The NHSA has issued a notice to promote the comprehensive advancement of real-time settlement reform, aiming for all coordinated areas to implement this by the end of 2025 [1] - By the end of 2026, at least 80% of designated medical institutions should be able to provide real-time settlement services [1] - The initiative encourages the inclusion of retail pharmacies in the real-time settlement framework [1] Group 2 - The notice mandates the standardization of fund disbursement mechanisms, requiring provincial healthcare departments to guide designated medical institutions to report medical expenses by the 10th of the following month [2] - Localities are encouraged to enhance the efficiency of real-time settlement processes through information technology, aiming to reduce the settlement cycle [2] - Funds should be disbursed within 20 working days after the reporting deadline, with a goal of completing payments by the end of the following month [2]