贯彻落实党的二十届四中全会精神权威访谈｜健全多层次医疗保障体系 筑牢民生保障底线——访国家医保局局长章轲

Core Insights - The article discusses the ongoing reforms in China's medical insurance system, emphasizing the establishment of a multi-tiered medical security system and the need for provincial coordination in basic medical insurance [1][9]. Group 1: Medical Insurance Reform Progress - 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]. - The "1+3+N" multi-tiered medical security system has been continuously promoted, with hospitalization reimbursement rates reaching approximately 80% for employee insurance and 70% for resident insurance [2]. - Over the "14th Five-Year Plan" period, medical insurance funds have cumulatively spent over 13 trillion yuan, benefiting nearly 20 billion patient visits [2]. Group 2: Future Directions for Medical Insurance - The "15th Five-Year Plan" will focus on strengthening the medical insurance system, addressing gaps, and promoting the development of commercial health insurance [4][9]. - The plan includes enhancing the basic medical insurance system and expanding funding channels, including encouraging social forces to participate in medical assistance [4]. - The establishment of a national unified medical insurance information platform is planned to support the construction of a multi-tiered medical security system [9]. Group 3: Payment and Service Improvements - The article highlights the need for further reforms in medical payment systems, focusing on total budget management and value-based payment [7][10]. - There will be an emphasis on optimizing the management of medical service prices and enhancing the collection and application of real-world data [7][8]. - The expansion of instant settlement reforms and the increase in the coverage of medical institutions for instant settlement funds are also key focuses for the upcoming period [11]. Group 4: Drug and Medical Service Management - The article mentions the ongoing efforts to improve the management of the medical insurance drug catalog, including dynamic adjustments and support for innovative drugs [8]. - The continuous optimization of drug procurement policies is highlighted, with a focus on ensuring quality and supply security for the public [11]. - The plan includes the establishment of a unified catalog for medical consumables and services across provinces to streamline processes [8].