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 Reforms - The reforms include direct settlement for cross-regional medical treatment, faster inclusion of innovative drugs into insurance, and improved access to quality and affordable medicines [1] - The national medical insurance work conference emphasizes the need to advance reforms and promote technological innovation to support healthcare and the pharmaceutical industry [1] Group 2: Financial Stability of Medical Insurance - 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 remaining stable at 95% [2] - By the end of 2024, the total income of the basic medical insurance fund is projected to be 3.49 trillion yuan, with total expenditures at 2.98 trillion yuan, resulting in a current balance of 463.92 billion yuan [2] Group 3: Aging Population Challenges - The aging population poses significant challenges to the medical insurance system, with the number of retired employees in the employee medical insurance system exceeding 100 million for the first time in 2024 [7] - The ratio of active to retired participants in the employee medical insurance system has been declining, indicating increased financial pressure on the insurance fund [7][8] Group 4: Provincial Coordination of Medical Insurance - The push for provincial-level coordination of medical insurance is seen as a crucial step in enhancing the insurance system's mutual assistance capabilities and risk resistance [8] - As of now, 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 Medical Market - The central government aims to accelerate the construction of a national unified market, particularly in the medical sector, to enhance resource allocation efficiency [10] - Over the past five years, significant progress has been made in cross-provincial direct settlement services, benefiting over 600 million people and reducing out-of-pocket expenses by over 660 billion yuan [11]