医保个人账户跨省共济落地，家庭互助重构医保生态

Core Viewpoint - The implementation of the cross-provincial mutual aid for employee medical insurance personal accounts marks a significant shift from provincial to national family mutual aid, addressing long-standing issues related to regional barriers and enhancing the healthcare ecosystem [1][13]. Policy Background - The evolution of the employee medical insurance personal account system has transitioned through three phases: a personal accumulation phase (1998-2020), a provincial family mutual aid phase (2021-2025), and now to a national family mutual aid phase starting in 2026 [2][3]. Key Highlights - The new policy breaks down regional barriers, allowing personal account funds to be used for medical expenses of relatives across provinces, thus addressing the issue of funds being idle while family medical needs exist [4]. - It enhances family mutual aid capabilities, alleviating the financial burden on children supporting elderly parents who are left behind in their hometowns [5]. - The policy simplifies the payment process for cross-provincial medical services, enabling direct settlement of expenses without the need for upfront payments [5]. Functional Positioning - The policy retains the personal accumulation attribute of the accounts, ensuring that funds remain the property of the insured while allowing for voluntary mutual aid among family members [7]. - It extends the mutual aid concept within families, creating a structure that combines large-scale mutual aid with family-level support [7]. - The cross-provincial mutual aid system is designed to improve the overall efficiency of fund usage, activating previously idle personal account funds [8]. New Policy Implementation - The settlement method for cross-provincial medical expenses shifts from reimbursement to direct settlement, significantly reducing administrative costs and improving efficiency [9]. - The accessibility of medical services expands from local to national levels, allowing insured individuals to choose healthcare providers across the country [9]. Industry Impact - The digital transformation of medical insurance services is accelerated, enhancing data integration and online settlement capabilities [10]. - The retail pharmacy and medical distribution sectors are undergoing structural adjustments due to increased demand for medications and supplies [10]. - The healthcare service supply system is strengthened, promoting better collaboration between primary care and specialized medical institutions [10]. Challenges and Responses - There is a need for enhanced policy communication to ensure that insured individuals understand the new system and its processes [12]. - Continuous improvement of the national unified medical insurance information platform is essential for stable operation [12]. - Strengthening regional policy coordination is necessary to minimize discrepancies in implementation across different areas [12].