中央决定推进医保省级统筹

Core Viewpoint - The acceleration of provincial-level medical insurance coordination in China is expected to enhance the autonomy of insured individuals, improve fairness in treatment, and streamline administrative services, while also presenting challenges for medical institutions due to increased competition and regulatory demands [4][10]. Summary by Sections Provincial-Level Coordination Implementation - The "14th Five-Year Plan" has achieved city-level coordination of medical insurance, and the "15th Five-Year Plan" aims to promote provincial-level coordination [6][7]. - Currently, 20 provinces have issued documents to advance provincial-level coordination, with two main models: unified collection and expenditure, and provincial adjustment funds [7][8]. 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 [10][11]. - Patients will no longer face the classification of inter-provincial medical treatment within the same province, leading to reduced administrative burdens and improved access to healthcare services [11][12]. Effects on Medical Institutions - The shift to provincial-level coordination may exacerbate the "siphoning effect" towards larger hospitals, increasing the need for smaller medical institutions to enhance their capabilities [4][12]. - The regulatory environment for large hospitals will become stricter, especially with the integration of inter-provincial medical treatment into Diagnosis-Related Groups (DRG) payment systems [12]. Policy and Management Enhancements - The national medical insurance work conference emphasizes the need for optimized fund budget management and enhanced responsibilities at provincial and municipal levels [8]. - The introduction of risk adjustment mechanisms aims to balance the financial pressures across regions, particularly benefiting areas with lower funding capabilities [7][11].