从37.87万到41.02万参保人背后的德城医保“答卷”

Core Viewpoint - The Decheng District Medical Security Bureau has made significant achievements in medical insurance development during the "14th Five-Year Plan" period, focusing on enhancing the health and well-being of the people, ensuring basic coverage, sustainability, and reform [1] Group 1: Universal Coverage and Fairness - The district aims to build a fair and adequate medical insurance system, achieving a steady increase in the number of insured individuals from 378,700 at the end of the "13th Five-Year Plan" to 410,200 by 2025, maintaining a high coverage rate [2] - The implementation of a unified treatment guarantee policy ensures fairness in benefits, with improvements in the basic medical insurance coverage for both employees and residents [2] - The introduction of outpatient insurance for employees marks a historic leap, with significant increases in annual payment limits, and the optimization of outpatient medication guarantees for chronic diseases [2] Group 2: Reform and Collaborative Governance - The district has initiated payment method reforms, including the Disease-Related Group (DRG) payment model, which has transformed the distribution of medical insurance funds and encouraged cost control in medical institutions [3] - The implementation of centralized procurement for drugs and medical supplies has led to an average price reduction of over 50%, saving patients over 300 million yuan in drug costs during the "14th Five-Year Plan" [3] - The establishment of a dual-channel management system ensures the accessibility of negotiated drugs and major disease medications, enhancing patient access to necessary treatments [3] Group 3: Service Optimization and Accessibility - A three-tiered medical insurance service network has been established, with 185 standardized service stations, facilitating local access to high-frequency services [4] - Breakthroughs in cross-regional medical settlement have been achieved, including the elimination of provincial registration procedures, greatly enhancing convenience for patients seeking care outside their home regions [4] - The integration of "Internet + Medical Insurance" has led to the promotion of electronic medical insurance certificates, streamlining the process for insured individuals [4] Group 4: Strengthening Regulation and Risk Prevention - The district prioritizes the safety of medical insurance funds, establishing a comprehensive regulatory framework that includes government oversight, social supervision, and industry self-discipline [5] - A high-pressure approach to fund supervision has resulted in strict actions against 146 non-compliant medical institutions, recovering 8.4428 million yuan in misused funds [5] - The use of technology, including big data analysis, is being explored to enhance non-site supervision capabilities and improve the precision of regulatory actions [6]