明年力争实现生娃基本“不花钱”,国家医保局最新消息发布

Group 1 - The National Medical Insurance Administration reported that the personal account mutual aid amount for employee medical insurance has exceeded 100 billion yuan, with over 7.8 billion mutual aid instances in the past five years [1] - A comprehensive outpatient medication guarantee mechanism for hypertension and diabetes has been established, benefiting over 340 million people through major illness insurance [1] - The medical insurance system will continue to support the development of medical institutions, with a full rollout of disease-based payment methods by 2025 [1] Group 2 - The implementation of version 2.0 of the disease-based payment scheme will be completed by 2025, with improvements in special case negotiations and prepayment mechanisms [2] - All medical insurance regions will conduct real-time settlements, reducing the payment timeline to within 20 working days, with some areas achieving next-day settlements [2] - By 2026, version 3.0 of the disease-based payment scheme will be released, supporting the clinical use of new drugs and technologies [2] Group 3 - The National Medical Insurance Administration aims to achieve "no out-of-pocket" expenses for childbirth within the policy scope by 2026, expanding maternity insurance coverage [3] - The maternity insurance program will cover approximately 300 million insured individuals, with 2.55 billion people currently enrolled [3] - By 2026, efforts will be made to include flexible employment workers and migrant workers in the maternity insurance coverage [3] Group 4 - Over the past five years, approximately 120 billion yuan has been recovered from medical insurance fraud, with comprehensive coverage of all provinces through regular inspections [4] - The use of big data models and intelligent supervision systems has helped recover 9.5 billion yuan in fund losses [4] - Continuous efforts will be made to strengthen inspections and maintain the integrity of medical insurance funds, with zero tolerance for illegal activities [5]