“十四五”期间 我国基本医保参保率稳定在95% 跨省异地就医直接结算超6亿人次

Core Insights - The National Healthcare Security Administration (NHSA) reported that during the 14th Five-Year Plan period, the basic medical insurance coverage rate in China remains stable at around 95%, with over 600 million instances of direct settlement for cross-provincial medical treatment [1] - The NHSA aims to enhance prenatal examination medical expense coverage based on the fund's capacity, targeting to achieve "no out-of-pocket" expenses for childbirth within the policy scope nationwide by next year [1] Group 1: Medical Insurance Coverage - Cumulative expenditure of the medical insurance fund exceeded 13 trillion yuan, benefiting nearly 20 billion medical visits [1] - The number of participants in the national maternity insurance reached 255 million, with nearly 95% of coordinated areas directly disbursing maternity allowances to individuals [1] Group 2: Drug and Medical Supplies Management - Over the past five years, the NHSA has organized the collection of drugs and high-value medical consumables, covering common diseases such as diabetes and cancer, as well as high-value items like artificial joints and cochlear implants [1] - The NHSA has implemented measures to expand the scope of cross-provincial direct settlement and broadened the mutual aid range of employee medical insurance personal accounts to include close relatives [1] Group 3: Fund Management and Regulation - The NHSA has intensified fund usage supervision, recovering 9.5 billion yuan in fund losses through big data models and intelligent regulation [2] - A total of over 100 billion drug traceability codes have been collected, effectively combating illegal activities [2] Group 4: Future Initiatives - In the coming year, the NHSA plans to empower high-quality development of medical institutions through reforms in fund prepayment and instant settlement [2] - The NHSA will continue to support innovation in the pharmaceutical industry and encourage commercial health insurance to include more reasonable medical expenses outside the basic medical insurance catalog [2]