国家医保局推进“季度清算”，医疗机构资金回笼将再提速

Core Viewpoint - The National Healthcare Security Administration (NHSA) is implementing a three-year action plan to enhance the efficiency of medical insurance fund settlement, aiming for timely payments to designated medical institutions and reducing the financial pressure on healthcare providers [1][2][4]. Group 1: Action Plan Overview - The action plan consists of three phases, with the first phase requiring all regions to complete the 2025 annual settlement by May 2026, and pilot areas by March 2026, adjusting the settlement fund proportion to around 5% of total fund disbursements [2]. - In the second phase, all regions must complete the 2026 annual settlement by April 2027, with pilot areas by March 2027, and the settlement fund proportion adjusted to between 3% and 5% [2]. - The final phase aims for all regions to complete the 2027 annual settlement by March 2028, maintaining the settlement fund proportion at around 3% [2]. Group 2: Immediate Settlement and Quarterly Clearing - The NHSA is promoting an immediate settlement system, with a target for 80% of local medical insurance funds to be settled monthly by the end of 2026, including employee and resident insurance funds [5]. - The introduction of a quarterly clearing mechanism is expected to significantly reduce the settlement cycle, allowing hospitals to receive funds more quickly, as evidenced by successful trials in regions like Suqian, Jiangsu [3][4]. - The focus on disease-based payment settlements is highlighted as a key challenge, with provincial healthcare departments encouraged to enhance communication and resolve disputes effectively [3]. Group 3: Financial Impact on Healthcare Institutions - The prolonged annual settlement cycle has historically strained cash flow for medical institutions, impacting their financial stability and the pharmaceutical supply chain [2]. - The NHSA's initiatives aim to alleviate the financial burden on healthcare providers, thereby improving the overall efficiency and effectiveness of medical insurance fund utilization [4].