20省发文推进医保省级统筹，医药统一大市场建设加速|数读“十四五”

Core Insights - The article discusses the ongoing reforms in China's medical insurance system during the 14th Five-Year Plan period, highlighting the release of institutional dividends that enhance public welfare and upgrade the pharmaceutical industry [1][2]. Group 1: Medical Insurance Reform - The current challenge for China's medical insurance system is balancing the fund's income and expenditure amid an aging population, particularly in regions with high elderly dependency ratios [1][2]. - The national medical insurance work conference emphasizes advancing medical insurance reforms and promoting technological innovation to support healthcare and the pharmaceutical industry [1][2]. Group 2: Fund Performance and Coverage - Over the past five years, the medical insurance fund has maintained stability, with total expenditures exceeding 13 trillion yuan, and the basic medical insurance coverage rate stabilizing at 95% [2]. - By the end of 2024, the total number of basic medical insurance participants is projected to reach approximately 1.33 billion, with total fund income of about 3.49 trillion yuan and expenditures of around 2.98 trillion yuan [2]. Group 3: Aging Population Impact - The number of retirees under the employee medical insurance system is expected to exceed 100 million in 2024, with medical expenses surpassing 1 trillion yuan [7]. - The ratio of employed to retired participants in the employee medical insurance system has been declining, indicating increased pressure on the fund [7][8]. Group 4: Provincial Coordination - The push for provincial-level coordination in medical insurance is seen as a significant institutional advancement, aimed at enhancing the fund's risk resistance and governance [8][9]. - Currently, 20 provinces have issued documents to promote provincial-level coordination, which is expected to improve the fairness and efficiency of medical insurance [8][9]. Group 5: National Unified Market - The central government aims to accelerate the construction of a unified national market, particularly in the pharmaceutical sector, to enhance resource allocation efficiency [13]. - The establishment of a unified medical insurance treatment list and the promotion of a standardized framework for basic medical insurance are key steps in this direction [13][14]. Group 6: Personal Account Utilization - The expansion of personal account utilization for employee medical insurance to include close relatives has been implemented, with over 7.8 billion instances of account sharing recorded [14]. - A national unified medical insurance information platform has been established, facilitating over 280 million daily settlements and significantly reducing out-of-pocket expenses for patients [14].