推进基本医保省级统筹

Core Viewpoint - The State Council's recent meeting marks a significant step towards the provincial-level coordination of basic medical insurance in China, transitioning from a "local scattered" system to a "provincial unified" approach [1] Group 1: Provincial Coordination Benefits - Provincial coordination aims to break regional barriers and restructure the underlying logic of medical insurance governance, enhancing the system's protective capabilities [1] - This reform is not merely a technical adjustment but a robust safeguard for the equitable right to medical care [1] - Currently, 20 provinces have initiated provincial-level coordination, with some provinces already experimenting with this model [1] Group 2: Current Challenges in Medical Insurance - The existing city-level coordination leads to significant disparities in the operation of medical insurance funds within the same province, influenced by varying fiscal support and funding levels [2] - This "honeycomb" policy structure results in different insurance payment standards and reimbursement ratios across cities, undermining the essence of mutual assistance in the medical insurance system [2] - The increasing demand for cross-regional medical services has highlighted these policy differences, leading to a growing public demand for improved coordination [2] Group 3: Reform Initiatives and Standardization - Several provinces are responding to public expectations by raising the coordination level and standardizing policies to ensure equitable benefits for all insured individuals [2] - For instance, Shanxi aims to achieve "six unifications" in its resident medical insurance by 2025, while Hunan has proposed unified standards for hospitalization and outpatient services [2] - This "one-size-fits-all" approach is intended to eliminate disparities in insurance coverage across different regions [2] Group 4: Future Considerations and Challenges - The implementation of provincial coordination will require balancing unified management with local engagement, addressing new challenges such as the pressure on high-level medical institutions and the potential neglect of grassroots healthcare [3] - The focus will be on improving the efficiency of fund usage and providing fair, accessible, and convenient medical services to the insured [3] - The integration of a tiered diagnosis and treatment system, along with enhancing the capacity of primary healthcare services, is essential for meeting public medical needs [3]