威海｜威海“十四五”医保改革释放多重惠民红利

Core Insights - During the "14th Five-Year Plan" period, Weihai's medical insurance fund operates smoothly, with both employee and resident insurance funds remaining within a sustainable range [1] - The reimbursement ratios for inpatient expenses are stable at over 80% for employees and over 65% for residents, with a 70% reimbursement for key assistance recipients [1] Group 1: Medical Insurance Fund Performance - The outpatient co-payment mechanism has been fully established, with 11.69 million outpatient reimbursements totaling 1.098 billion yuan [1] - Major medical insurance provides a maximum reimbursement rate of 90% for high-cost medical expenses, with cumulative payments of 609 million yuan for major medical insurance and 208 million yuan for medical assistance over five years [1] - Long-term care insurance has achieved full coverage for employees, with pilot programs for residents, totaling 130 million yuan in benefits distributed over five years [1] Group 2: Medical Service Pricing and Reforms - Weihai has conducted 22 dynamic adjustments to medical service prices over five years, adding 105 new service items and adjusting 664 prices [2] - The implementation of DRG payment reform has led to a 16% decrease in average hospitalization costs compared to the end of the "13th Five-Year Plan" [2] - The number of drugs in the medical insurance reimbursement directory has increased from 2,709 to 3,159, with 600 types of negotiated drugs included, enhancing patient access to affordable treatment [2] Group 3: Accessibility and Service Improvements - The network for cross-province medical settlement has expanded significantly, with 144 hospitals and 1,552 pharmacies supporting direct settlement [3] - The activation of medical insurance electronic certificates has reached 2.48 million, with mobile payment coverage exceeding 85% [3] - Six services, including "newborn birth," have been streamlined to allow for single-visit processing, improving the overall experience for the public [3]