会议讨论环节由山东第二医科大学附属医院医保管理办公室主任玄桂英主持，潍坊市人民医院运营发展 部主任程英利、潍坊市第二人民医院医保办副主任王敏、昌乐县人民医院医保物价科主任钟杰、潍坊市 妇幼保健院医保科主任钱秀玲、青州市人民医院副院长张娜分别围绕当前医保改革中的热点难点问题分 享了各家医院的成功经验与创新做法，为今后工作的开展提供了新思路、新方法。 11月21日，由潍坊市人民医院承办的潍坊市医学会第二届医疗保险专业委员会第六次学术会议顺利召 开。潍坊市人民医院党委副书记、院长王红波致辞，党委委员、副院长李晓东，党委委员、副院长宿希 龙参加开幕式。潍坊市医学会医疗保险专业委员会主任委员赵桂凤主持开幕式。 本次年会不仅是一场高水平的学术盛宴，更是一次凝聚共识、面向未来的行业盛会。作为主委单位，潍 坊市人民医院将继续与各成员单位携手共进，汇聚专业智慧，共同推动本市医院医保管理事业再上新台 阶，为参保群众提供更加优质、高效的医疗服务。 会议特邀了多位国内及省内知名医保、医疗管理专家进行精彩授课。专家们围绕支付方式改革、医院运 营管理、医保医疗协同发展等进行了深入浅出的讲解与研讨。 本次会议吸引了来自全市各级医疗机构的院 ...

Core Insights - During the "14th Five-Year Plan" period, Shandong's medical insurance benefits have steadily improved, with the hospitalization reimbursement ratio for grassroots medical institutions exceeding 85% [1][2] Group 1: Medical Insurance Reforms - The hospitalization reimbursement ratios for employee and resident medical insurance remain stable at approximately 80% and 70%, respectively [2][3] - A comprehensive outpatient coordination system has been established, increasing the reimbursement ratio for outpatient services at grassroots medical institutions to 65% [3] - The reimbursement ratio for outpatient medications for residents with hypertension and diabetes has been raised to 75% [3] Group 2: Support for Vulnerable Groups - The rescue ratio for major disease medical insurance and assistance for vulnerable groups, including low-income families, has been increased to over 70% [3] - Shandong has achieved nationwide coverage for long-term care insurance for employees and is steadily advancing long-term care insurance for residents [3] Group 3: Collaborative Development in Healthcare - Shandong has been actively promoting centralized procurement of drugs and medical consumables, with 890 types of drugs and 40 categories of high-value medical consumables procured over the past five years [4] - The province has implemented a payment reform based on disease diagnosis-related groups (DRG) and disease-specific values (DIP), achieving coverage rates of 97.21% for disease types and 89.76% for funds [4] Group 4: Optimization of Public Services - The province has maintained a stable insurance coverage rate of 95% for the resident population during the "14th Five-Year Plan" period [5] - The direct settlement rate for cross-province hospitalization has improved from less than 50% during the "13th Five-Year Plan" to 94.49% [5] - A total of 35,000 grassroots medical insurance workstations have been established, achieving full coverage of the five-tier medical insurance service system [5]

（原标题：小药盒，大政策：慢性病证明与医保改革的民生共鸣） 小药盒，大政策：慢性病证明与医保改革的民生共鸣 （作者：张硕、李鑫霖、姚早晖、王艳曦 指导老师：陈广宁） 清晨六点，72岁的退休教师张桂兰准时坐在餐桌前，将降压药、冠心病药、补钾片分门别类摆开。这个 动作她已重复了二十多年，药盒从最初的单一纸盒变成如今的多层药盒，而伴随药盒变化的，还有她手 里的医保账本——"2020年这药360块得全自付，现在36块就够了。"从2023年到2025年，吉林省职工医 保政策三次调整，让她每月的药费负担一直在减少。 与此同时，68岁的农民王建国正拿着医保卡去社区医院买降压药。在他的药盒里，高血压药占了大半。 王建国患高血压已十年，但由于他所参与的居民医保对高血压药品的补贴微乎其微，每个月百余元药费 对于他这样的农民家庭来说是不小的负担。 药盒里的药片，是老年慢性病患者的"生命线"；药盒外的医保政策，则是这条"生命线"的重要支撑。来 自国家卫生健康委的数据显示，全国60岁及以上人口达2.9亿，其中患慢性病人数超1.9亿。他们用药负 担的轻重与医保政策的迭代之间的关联，是观察民生保障与社会政策演进的重要窗口。 个人账户之变： ...

以前医保有个小问题，就是个人账户里的钱用得不科学。比如你工资高，医保个人账户里就存得多，平时看病花不了，钱就躺在那里"睡大觉"；而工资低的 人，个人账户钱少，看病时反而更困难。这就像你家有两个存钱罐，一个装得满满的，一个空空的，但大家看病都要从自己罐里拿钱，公平性差。 更麻烦的是，以前医保主要保住院，不怎么保门诊。大家得个感冒、肠胃不舒服，得去大医院排队挂号，花冤枉钱。很多慢性病患者一年门诊花几千块，医 保只报一半，自己还得掏一大笔。这就像你买菜，菜价涨了，但你只能按原价买，多花的钱得自己补。 医保基金本身也在"长胖"。2024年全国医保基金总收入2.8万亿，支出2.6万亿，虽然还有结余，但增长越来越慢。如果再不调整，以后可能连基本的医疗保 障都保不住了。这就像你钱包里的钱，每个月进账固定，但花销越来越大，不调整开支，迟早会"破产"。 前几天，我邻居王大爷拿着手机，一脸兴奋地跟我说："听说11月开始医保要取消了，看病住院能全额报销！"我接过手机一看，又是一条被传得神乎其神的 医保谣言。其实，这些消息都是假的，医保并没有取消个人账户，更不可能实现住院全额报销。今天，我就用大白话跟大家聊聊医保改革的真相，特别是为 ...

Core Points - The U.S. government shutdown, lasting 43 days, has officially ended with President Trump signing a funding bill, marking a historic resolution to the fiscal impasse [1][3] - The shutdown was primarily caused by disagreements over healthcare subsidies, particularly the extension of tax credits under the Affordable Care Act (ACA), which Democrats insisted upon as a condition for reopening the government [5] Legislative Process - The House of Representatives passed the funding bill with a vote of 222 in favor and 209 against, following its approval in the Senate [3] - House Speaker Mike Johnson expressed relief over the reopening of the government and criticized Democrats for using the American people as political pawns [3] Healthcare Subsidies - The funding bill did not include the requested extension of ACA tax credits, which was a significant demand from Democrats aimed at preventing premium increases for millions of insured individuals [5] - The absence of this provision indicates that healthcare issues will continue to be a contentious topic in Congress despite the end of the shutdown [5] Bipartisan Efforts - Following the passage of the funding bill, bipartisan efforts emerged to propose a separate bill aimed at extending ACA tax credits for two years [5][6] - The proposed compromise seeks to address concerns over rising premiums while implementing reforms to avoid increasing the deficit, including measures to combat fraudulent practices in healthcare billing [6]

Investment Rating - The report maintains a "Hold" rating for the OTC leading companies in the traditional Chinese medicine sector, indicating resilience compared to the broader market [5]. Core Insights - The traditional Chinese medicine sector continues to face performance pressure in Q3 2025, with significant differentiation among listed companies [2]. - The overall revenue growth rate for the traditional Chinese medicine sector in Q3 2025 was -1.57% year-on-year and -6.15% quarter-on-quarter, with a net profit decline of -5.25% year-on-year and -29.32% quarter-on-quarter [4][43]. - The sector's performance is influenced by policy changes, market conditions, and cost pressures, particularly in retail and hospital channels [48]. Summary by Sections 1. Market Review - From the beginning of 2025 to November 5, 2025, 49 out of 69 listed companies in the traditional Chinese medicine sector saw their stock prices increase, with notable gains from Wanbangde and Tianmu Pharmaceutical exceeding 100% [4][36]. - In Q3 2025, 46 companies reported stock price increases, with Wanbangde, Zhendong Pharmaceutical, and Weikang Pharmaceutical leading the gains [4][38]. 2. Performance Review - The overall revenue for the traditional Chinese medicine sector decreased by 4.28% year-on-year in the first three quarters of 2025, with Q3 showing a smaller decline of 1.57% [43]. - The net profit for the sector also saw a year-on-year decrease of 1.23% in the first three quarters of 2025, with Q3 reflecting a decline of 5.25% [46]. - Among 69 listed companies, 26 reported year-on-year revenue growth, while 25 showed quarter-on-quarter growth in Q3 2025 [51]. 3. Valuation - As of November 10, 2025, the price-to-earnings ratio (TTM) for the traditional Chinese medicine sector was 28.51, with historical percentiles indicating a trend of increasing valuations since 2020 [4].

Core Insights - The company reported better-than-expected performance in Q3 2025, with net profit increasing by 176.4% year-on-year to 1.291 billion yuan, driven by higher-than-expected investment returns [1] - The company continues to see steady premium growth and improvement in the combined cost ratio, with insurance business revenue up 5.6% year-on-year to 26.93 billion yuan [1] - The company maintains a positive outlook on its health insurance and auto insurance sectors, benefiting from healthcare reform and expansion opportunities in the new energy vehicle insurance market [1] Financial Performance - Q3 2025 net profit reached 1.291 billion yuan, while the net profit for the first nine months of 2025 was 1.859 billion yuan, reflecting a year-on-year increase of 206.9% [1] - The company's net assets increased by 22.7% quarter-on-quarter to 25.261 billion yuan [1] - Investment returns for Q3 2025 were 1.53%, up 1.1 percentage points year-on-year, while the comprehensive investment return was 2.97%, up 2.4 percentage points year-on-year [1] Business Development - The company’s Hong Kong virtual bank, ZA Bank, has launched Hong Kong stock trading services and surpassed 1 million users, achieving profitability for the first half of 2025 [2] - The strategic development of the Hong Kong banking business is seen as forward-looking, with potential for strong financial flexibility as wealth management services continue to upgrade [2] Earnings Forecast and Valuation - The company is currently trading at 0.9x 2025 estimated price-to-book ratio, with an upgraded earnings per share (EPS) forecast for 2025 and 2026 by 68% and 12% to 1.22 yuan and 0.94 yuan respectively [2] - The target price is maintained at 23.0 HKD, corresponding to a 1.3x 2025 estimated price-to-book ratio and a 42% upside potential [2]

Group 1 - The National Healthcare Security Administration successfully conducted negotiations for the 2025 National Basic Medical Insurance Drug List, with 120 companies participating and 127 drugs involved in the bidding process [1] - The new drug list is set to be released in the first weekend of December and will be implemented starting January 1, 2025, indicating ongoing optimization of the dynamic adjustment mechanism for the medical insurance catalog [1] - The dual catalog approach aims to expand basic medical coverage while leveraging commercial insurance to provide supplementary payment for innovative drugs, enhancing accessibility to advanced therapies [1] Group 2 - Baiyang Pharmaceutical signed a distribution agreement with Junxin Pharmaceutical for the exclusive promotion and sales rights of human albumin in specific markets, indicating a strategic expansion in the human albumin sector [2] - This collaboration will enhance the market reach into retail and hospital sectors, marking a significant step in optimizing the product pipeline for Baiyang Pharmaceutical [2] Group 3 - HeFu China announced that its stock price had deviated significantly from its fundamentals, with a cumulative increase of 77.4% over six consecutive trading days, raising concerns about market speculation and irrational trading behavior [3] - The company confirmed that there were no undisclosed significant matters affecting its business, but the stock's rapid rise poses a risk of a swift decline due to market overheating [3] - Regulatory bodies are urged to monitor irrational speculation and guide the market back to value investing principles [3] Group 4 - Fuhong Hanlin presented key updates on its PD-L1 ADC HLX43 for treating non-small cell lung cancer (NSCLC) at an international forum, showcasing results from a multi-center Phase II clinical study [4] - The data confirmed the efficacy and safety of HLX43, paving the way for subsequent Phase III studies by establishing the recommended dosage [4] - This research highlights the clinical value of HLX43 in treating NSCLC and other solid tumors, reinforcing its potential in the oncology market [4]

Core Points - The 20th Central Committee's Fourth Plenary Session emphasizes increasing efforts to guarantee and improve people's livelihoods, with a focus on medical security as a significant aspect of social development [1][2] - The "14th Five-Year Plan" period has seen historic achievements in China's medical security, contributing to solving the global challenge of healthcare reform and laying a solid foundation for the "15th Five-Year Plan" [1] - The National Medical Insurance Administration has organized 10 batches of centralized drug procurement, resulting in an average price reduction of over 50% for 435 drugs, saving thousands of billions in drug costs [1] - By the end of 2024, approximately 1.327 billion people are expected to be covered by basic medical insurance, maintaining a coverage rate of over 95% [1] Summary by Sections Medical Security Achievements - The "14th Five-Year Plan" has led to significant reductions in the financial burden of medical expenses for the public through targeted reforms [1] - The centralized procurement model has effectively reduced unreasonable costs in the drug distribution chain [1] Future Directions - The "15th Five-Year Plan" aims to enhance the fairness, sustainability, and effectiveness of the medical insurance system, addressing disparities in benefits among different groups [2] - Recommendations include improving the dynamic adjustment mechanism for funding and benefits, and enhancing the performance of medical services and fund utilization [2]

Core Insights - The article highlights significant achievements in China's healthcare system during the 14th Five-Year Plan, emphasizing improvements in health service capacity, accessibility, and equity, leading to a notable enhancement in public health [1] Group 1: Medical Technology Advancements - The launch of NanoForge, the world's first AI nano drug delivery platform, marks a breakthrough in drug development, enhancing the efficiency of RNA and small molecule drug delivery [2] - China now accounts for over 20% of new drug research globally, ranking second in new drug development, with several innovative drugs approved, including the anti-tumor drug Zebutinib [2] - The development of domestic medical devices, such as photon-counting CT and orthopedic surgical robots, has improved treatment precision and patient outcomes [3] Group 2: Healthcare Service Quality Improvement - The "Xi He No. 1" AI model has been developed to provide remote medical advice, significantly reducing misdiagnosis rates and improving patient survival chances [4] - The healthcare system aims to decentralize medical services, ensuring that serious illnesses are treated within provinces, while general and routine care is accessible at the community level [4] - By 2024, the total number of healthcare institutions in China is expected to reach 1.09 million, with a workforce of 15.78 million healthcare professionals [6] Group 3: Medical Insurance Expansion - The introduction of the "medical insurance wallet" allows for the transfer of personal account funds across provinces, enhancing the convenience of medical payments for families [7] - A comprehensive medical insurance system has been established, with over 12.36 billion people using the medical insurance code, facilitating easier access to healthcare services [8] - The implementation of long-term care insurance has benefited 1.9 million people, addressing the needs of individuals requiring long-term care [8] Group 4: Cost Reduction and Service Enhancement - Various healthcare policies have collectively reduced the financial burden on low-income populations by over 650 billion yuan, while drug price governance has significantly lowered medication costs [9] - The establishment of a unified national medical insurance information platform has improved service efficiency, with direct settlement for cross-province medical services increasing dramatically [9] - The ongoing development of China's healthcare system is closely aligned with the public's health aspirations, promising more affordable and quality health services in the future [9]