“个人医保云”试点申报启动 破解跨区域医保痛点

Core Insights - The National Healthcare Security Administration (NHSA) has announced a pilot program for the construction of a "Personal Medical Insurance Cloud" from February to December 2026, aimed at creating a new paradigm for smart healthcare management that covers the entire population and lifecycle [1][4] - The pilot will focus on three main areas: enhancing healthcare data governance, expanding data sources, and building dynamic multi-dimensional profiles for insured individuals [1][2] Group 1: Pilot Program Details - The pilot program will deepen healthcare data governance by integrating and managing core business data from designated medical institutions in real-time, ensuring data accuracy and completeness [1] - It will explore the integration of public health and health management data, particularly from wearable devices and home monitoring equipment, to effectively merge in-hospital and out-of-hospital health data [1][2] - A dynamic multi-dimensional profile will be created for each insured individual, incorporating health records, medical history, and financial data to provide personalized health recommendations and insights [2] Group 2: Benefits and Innovations - The Personal Medical Insurance Cloud aims to resolve common issues faced by the public, such as information silos and redundant paperwork, allowing insured individuals to manage their insurance affairs conveniently through mobile apps and online platforms [3][4] - The platform will prioritize data security through encryption, privacy calculations, and authorized access, ensuring that personal information and medical data are protected [3] - Future innovations may include personalized health management advice and precise policy notifications based on individual health data, enhancing user experience and supporting the reform of healthcare payment methods [3][4] Group 3: Implementation and Future Outlook - The pilot will be implemented in phases, initially focusing on breaking down data barriers and ensuring system stability, with plans to expand services based on feedback [5] - The initiative is seen as a critical step in reforming the healthcare security system, shifting from an institution-centered approach to one that prioritizes the insured individuals [4][5] - As the Personal Medical Insurance Cloud expands, it is expected to provide each insured person with a "healthcare manager," simplifying the reimbursement process and enhancing transparency and efficiency in healthcare services [5]