明年力争实现生娃基本“不花钱” 国家医保局最新消息发布

Core Insights - The National Medical Insurance Administration (NMIA) has announced several measures and data at the National Medical Security Work Conference, highlighting improvements in medical insurance coverage and support for healthcare institutions. Group 1: Medical Insurance Coverage - The total amount of personal accounts for employee medical insurance has exceeded 100 billion yuan, with over 7.8 billion instances of account sharing in the past five years [2] - A comprehensive outpatient medication guarantee mechanism for hypertension and diabetes has been established, benefiting over 340 million people through major illness insurance [2] - Medical assistance has reached 1.189 billion people, with over 90% reimbursement for rural disadvantaged groups [2] Group 2: Support for Healthcare Institutions - By 2025, the NMIA will implement a comprehensive payment reform based on disease categories, with a 2.0 version of the payment scheme to be introduced [3] - All medical insurance areas will conduct real-time settlements, reducing the payment timeline to within 20 working days after submission, with some areas achieving next-day settlements [3] - The NMIA plans to release a 3.0 version of the payment scheme by 2026, promoting the use of new drugs and technologies in clinical settings [3] Group 3: Maternity and Long-term Care Insurance - The NMIA aims to achieve "no out-of-pocket" expenses for childbirth within policy coverage by 2026, expanding maternity insurance to cover flexible employment and migrant workers [4] - The long-term care insurance system is being developed to cover approximately 300 million insured individuals, benefiting over 3.3 million disabled individuals [4] - Nearly 95% of insurance areas will directly distribute maternity benefits to insured individuals [4] Group 4: Anti-fraud Measures - Over the past five years, approximately 120 billion yuan has been recovered from fraudulent medical insurance claims, with comprehensive coverage of inspections across all provinces [5] - The NMIA has utilized big data models and intelligent regulatory systems to recover 9.5 billion yuan in fund losses [5] - In 2026, the NMIA will enhance inspection efforts, focusing on areas with high out-of-pocket rates and ensuring strict penalties for fraudulent activities [6]