退休参保人员首超1亿，医保面临这些挑战

Core Viewpoint - The article highlights the profound impact of population aging on China's medical insurance system, indicating that the number of retired insured individuals has surpassed 100 million for the first time in 2024, leading to significant challenges in funding balance, intergenerational burden adjustment, and system sustainability [1][2]. Group 1: Medical Insurance Statistics - By the end of 2024, the total number of participants in basic medical insurance reached 1.32662 billion, maintaining a coverage rate of 95% [1]. - The total revenue of basic medical insurance (including maternity insurance) was 3.491337 trillion yuan, while total expenditures were 2.976403 trillion yuan, resulting in a current balance of 463.917 billion yuan and a cumulative balance of 3.862852 trillion yuan [1]. - The number of participants in basic medical insurance has declined for three consecutive years, while the number of participants in employee medical insurance continues to grow, with retirees seeing a significant increase in participation [1][4]. Group 2: Employee Medical Insurance Insights - As of 2024, the number of participants in employee medical insurance reached 379.4834 million, an increase of 8.537 million or 2.3% from the previous year [4]. - The medical expenses for employee medical insurance participants totaled 2.058746 trillion yuan in 2024, reflecting a 3.6% increase year-on-year [5]. - The income of the employee medical insurance fund (including maternity insurance) was 2.373247 trillion yuan, a 3.5% increase from the previous year, while expenditures rose by 7.6% to 1.910254 trillion yuan [5]. Group 3: Challenges of Aging Population - The ratio of employed to retired individuals in employee medical insurance has been declining, with the ratio dropping from 3 in 2012 to an estimated 2.63 in 2024 [5]. - The increasing number of retirees, who do not contribute to the fund, places additional financial pressure on the medical insurance system, necessitating reforms to address the sustainability of the fund [6]. - The rapid growth of the elderly population is expected to continue, with an annual net increase of over 13 million individuals aged 60 and above in the next five years [11]. Group 4: Resident Medical Insurance Trends - The number of participants in resident medical insurance has been declining since 2021, with a decrease of over 7 million participants from its peak of 1.02 billion in 2019 to 950 million in 2024 [9]. - In 2024, the income of the resident medical insurance fund was 1.118091 trillion yuan, with expenditures of 1.066149 trillion yuan, resulting in a current balance of 51.942 billion yuan [10]. - Despite a slight rebound in income growth of 5.8% in 2024, the resident medical insurance remains in a "tight balance" state, indicating ongoing sustainability challenges [10]. Group 5: Long-term Care Insurance Development - The article discusses the anticipated introduction of a nationwide long-term care insurance system, with 18.78634 million participants in pilot cities and 1.4625 million receiving benefits in 2024 [13]. - The income for long-term care insurance was 24.415 billion yuan, with expenditures of 13.108 billion yuan, indicating a growing need for such services in response to the aging population [13]. - The healthcare system is expected to evolve to better accommodate the needs of elderly individuals, particularly in chronic disease management and long-term care [13].