中央决定推进医保省级统筹

Core Viewpoint - The acceleration of provincial-level medical insurance coordination in China by 2026 is expected to enhance the autonomy of insured individuals, improve fairness in treatment, and streamline administrative services, while also presenting challenges for medical institutions [1][3]. Group 1: Provincial-Level Coordination Implementation - The "14th Five-Year Plan" has achieved city-level coordination, and the "15th Five-Year Plan" aims to advance provincial-level coordination [3]. - Currently, 20 provinces have issued documents to promote provincial-level coordination [1]. - Two main models for provincial-level coordination are identified: unified collection and expenditure, and a more common provincial adjustment fund model [3][4]. Group 2: Impact on Insured Individuals - Provincial-level coordination will create a larger medical insurance fund pool, enhancing risk resistance and reducing disparities in treatment across the province [5]. - The implementation in Guizhou province has shown that unified policies can stabilize chronic disease coverage and improve emergency medical services [5]. - The elimination of policy barriers within provinces will reduce the need for patients to travel for care, thus decreasing the number of interprovincial medical visits [5][6]. Group 3: Effects on Medical Institutions - The shift to provincial-level coordination is expected to increase patient flow to larger hospitals, potentially squeezing the survival space of healthcare institutions in less developed areas [6][7]. - The "siphoning effect" of larger hospitals will necessitate stronger regulatory oversight of medical insurance [6]. - The balance between payment entities and service providers will continue to evolve, with a focus on managing the influx of patients to high-quality medical resources [6][7]. Group 4: Policy Adjustments and Challenges - The policy aims to unify treatment standards across regions while still considering local funding levels [7]. - Adjustments to payment ratios for interprovincial and intraprovincial medical services are being proposed to promote fairness [7].