国家医保局局长章轲：健全多层次医疗保障体系 筑牢民生保障底线

Core Viewpoint - The article emphasizes the importance of establishing a multi-tiered medical insurance system to enhance public health security, as outlined in the recommendations from the 20th Central Committee of the Communist Party of China [1][2]. Group 1: Progress in Medical Insurance Reform - Since the 18th National Congress, the reform of the national medical insurance system has significantly improved the quality of insurance coverage, enhancing public satisfaction [2][3]. - The "1+3+N" multi-tiered medical insurance system has been continuously promoted, with hospitalization reimbursement rates reaching approximately 80% for employee insurance and 70% for resident insurance [2][3]. - Cumulatively, over 13 trillion yuan has been spent from the medical insurance fund during the 14th Five-Year Plan, benefiting nearly 20 billion medical visits [2][3]. Group 2: Future Directions for Medical Insurance Development - The "15th Five-Year Plan" will focus on strengthening the medical insurance system, addressing gaps, and promoting the participation of flexible employment and new employment forms in basic medical insurance [4][5]. - The plan aims to enhance collaboration among medical services, medical insurance, and pharmaceuticals, utilizing data and funding as dual engines for development [5][6]. - A nationwide unified medical insurance information platform will be established to support the construction of a multi-tiered medical insurance system [20][21]. Group 3: Payment and Pricing Reforms - The reform of medical insurance payment methods will continue, focusing on total budget management and value-based payment systems [17][18]. - The article highlights the need for dynamic adjustments to the medical insurance drug list and the establishment of a unified management system for medical consumables and services [18][21]. - The expansion of instant settlement reforms will be prioritized, aiming to enhance the efficiency of medical insurance fund usage and support high-quality development of medical institutions [21][22].