“十四五”时期，济宁医疗保障事业高质量发展

Core Viewpoint - The Jining medical insurance system has achieved significant progress in high-quality development during the "14th Five-Year Plan" period, focusing on basic protection, benefiting people's livelihoods, promoting reforms, and strengthening regulation to address issues of difficult and expensive medical care for the public [1]. Group 1: Multi-layered Guarantee System - The Jining medical insurance system has established a four-tier guarantee structure consisting of basic medical insurance, serious illness insurance, medical assistance, and commercial supplementary insurance, effectively addressing the public's healthcare needs [2]. - Outpatient benefits have been enhanced, with maximum payment limits for employed and retired individuals raised to 4500 yuan and 5500 yuan respectively, and reimbursement rates for outpatient services increased by 10% [2]. - Inpatient benefits have been improved, with the maximum payment limit raised to 200,000 yuan and reimbursement rates for grassroots inpatient care increased to 85% [2]. Group 2: Reducing Medical and Drug Burdens - The Jining medical insurance system has implemented a series of policies to reduce the financial burden of medical care and medication for the public, including continuous increases in outpatient reimbursement standards and maintaining the lowest payment threshold in the province [4]. - The average reduction in personal medical expenses has been 34.79%, with the DIP payment coverage reaching 100%, completing the reform task a year ahead of schedule [4]. - The centralized procurement of drugs has resulted in an average price reduction of over 50%, benefiting the public by saving on medication costs [4]. Group 3: Long-term Care Insurance - The long-term care insurance system has been steadily advanced, with over 62 million yuan paid out to 62,500 disabled individuals, effectively alleviating the care burden on families [5]. Group 4: Fund Security and Regulation - The Jining medical insurance system has established a comprehensive regulatory framework to ensure the safety and stability of the medical insurance fund, ranking among the top in provincial evaluations for three consecutive years [6]. - Over 31,800 inspections of designated medical institutions have been conducted, recovering over 200 million yuan in misused funds and imposing fines exceeding 7.5 million yuan [7]. Group 5: Improving Service Quality - The Jining medical insurance system has focused on optimizing service processes and enhancing service efficiency, achieving a high insurance coverage rate and improving the convenience of medical services [8]. - The activation of medical insurance codes has reached 8 million, with significant advancements in mobile payment and inter-city medical settlement processes [9]. - Future plans include summarizing successful experiences from the "14th Five-Year Plan" and continuing to deepen reforms and improve the medical insurance system [9].