多领域成效斐然，2025年德州医保“成绩单”来了

Core Viewpoint - In 2025, Dezhou's medical insurance work has made significant progress and achievements under the strong leadership of the municipal government, focusing on the principle of "medical insurance for the people" and implementing various reforms and innovations to enhance the medical insurance system [1] Group 1: Financial Performance - The overall operation of the medical insurance fund is stable, with a total income of 8.622 billion yuan and total expenditure of 7.522 billion yuan from January to November, resulting in a current surplus of 1.1 billion yuan and a cumulative surplus of 9.173 billion yuan [2] - The employee medical insurance fund generated an income of 4.441 billion yuan and an expenditure of 3.532 billion yuan, leading to a current surplus of 909 million yuan and a cumulative surplus of 5.598 billion yuan [2] - The resident medical insurance fund had an income of 4.181 billion yuan and an expenditure of 3.99 billion yuan, resulting in a current surplus of 190 million yuan and a cumulative surplus of 3.575 billion yuan [2] Group 2: Policy Implementation - The city has completed the "efficient handling of one matter" reform in the medical insurance sector, facilitating medical expense reimbursement through various channels, achieving 96,300 online transactions by December 15 [3] - Long-term care insurance has been expanded and improved, with 79 designated institutions and 32,700 assessments completed, benefiting 23,700 disabled individuals with a total of 377 million yuan in care benefits [3] - A special action to enhance convenience in medical insurance services has been launched, achieving 14,600 offline cross-regional transactions and upgrading core systems for timely data extraction [3] Group 3: System Improvement - The adjustment of resident medical insurance benefits has been made to enhance payment capabilities, with changes in hospitalization thresholds and reimbursement ratios for different medical institutions [4] - Medical assistance has been provided to 114,000 individuals, with expenditures of 44.884 million yuan, and 289,900 beneficiaries enjoying medical treatment [4] - The integration of major illness insurance and employee high-cost medical expense subsidies has been piloted to improve fund pooling and reduce operational costs [4] Group 4: Supply-side Reform - Payment method reforms have been implemented, leading to a 2.78% reduction in average hospitalization costs compared to the previous year [5] - The centralized procurement of drugs and consumables has saved patients 5.727 billion yuan, with 890 types of drugs and 43 categories of consumables executed [5] - The number of designated traditional Chinese medicine institutions has increased from 81 to 122, promoting the integration of traditional and Western medicine [5] Group 5: Service Capability Enhancement - The medical insurance settlement process has been optimized, reducing the settlement cycle to 15 working days, with 12,600 individuals benefiting from maternity allowances totaling 138 million yuan [6] - The management of designated medical institutions has been strengthened, with 4,169 institutions dynamically managed [6] - The number of individuals insured reached 5.1242 million, achieving a completion rate of 97.70% for the year [6] Group 6: Reform Achievements - The city has deepened payment method reforms and developed a new version of the DIP disease catalog, supporting high-tech medical institutions [7] - Efforts to secure national pilot projects have resulted in the establishment of a smart supervision pilot and two provincial pilot projects for electronic medical records [7] - The "pay after treatment" model has signed up 114,000 individuals, with 85,000 services provided, and the medical insurance wallet pilot has facilitated over 6,500 transactions [7]