Core Viewpoint - The recent reforms in medical insurance payment methods, particularly the special single negotiation mechanism, aim to support the use of innovative drugs and medical devices, addressing concerns about high costs in medical institutions [1][3][4]. Group 1: Special Single Negotiation Mechanism - The special single negotiation mechanism is designed to provide reasonable compensation for medical services when the costs exceed three times the payment standard [2][4]. - The mechanism will be refined in conjunction with national policies supporting the development of innovative drugs and medical devices, indicating a commitment to support medical institutions in treating complex and critical patients [3][4]. - The number of cases eligible for special single negotiation should not exceed 5% of the total discharged cases under the DRG or DIP payment systems [4]. Group 2: Impact on Innovative Drugs - The reforms are expected to benefit drugs listed in the commercial health insurance innovative drug directory, particularly those with high clinical value and patient benefits [5][6]. - The introduction of the commercial health insurance innovative drug directory is anticipated to provide a framework for local authorities to evaluate and implement the special single negotiation policy effectively [5][7]. - Local governments, such as those in Hainan and Guangzhou, are developing their own innovative drug directories to enhance the support for innovative drugs and medical devices [8][9]. Group 3: Regional Initiatives - Regions with relatively abundant medical insurance funds, like Shanghai and Zhejiang, have already launched local supportive directories for innovative drugs and devices [8][10]. - The Zhejiang Medical Security Bureau has established a list of innovative medical technologies eligible for payment incentives, focusing on drugs that have recently entered the basic medical insurance directory [11][12]. - Shanghai has implemented a strategy to adjust payment standards for cases involving new technologies, allowing for full payment without a control ratio for high-cost cases [12].

Core Viewpoint - The article emphasizes the importance of reforming the medical insurance payment system in China, particularly focusing on the implementation of a disease-based payment system to enhance efficiency and transparency in healthcare funding [1][2]. Background of the Regulation - The introduction of the interim measures for disease-based payment management is aimed at promoting standardized behavior among medical institutions, controlling costs, optimizing resource allocation, and improving the efficiency of medical insurance fund usage [2]. - The National Healthcare Security Administration has been advancing the disease-based payment model over the past six years, achieving nationwide coverage and improving the management system [2]. Main Content of the Regulation - The interim measures consist of eight chapters and thirty-nine articles, focusing on establishing a unified, efficient medical insurance payment system that supports high-quality development of medical institutions [3]. - Key aspects include: - Standardizing total budget management to ensure a balanced budget and stable expectations for medical institutions [3]. - Defining the framework for grouping schemes and their adjustments, with a requirement for biennial updates [3][5]. - Clarifying core elements and supporting measures, including payment standards and negotiation processes [3]. Regulations on Grouping Schemes - The National Healthcare Security Administration is designated as the authority for developing and adjusting grouping schemes, ensuring consistency across regions [4]. - The grouping framework includes major diagnostic categories and core groups, with adjustments based on historical cost data and feedback from medical institutions [5]. Positive Effects on Medical Institutions - The regulation enhances transparency in total budget management, allowing for better financial planning by medical institutions [6]. - It provides clearer technical standards and a predictable adjustment cycle for grouping schemes, aligning them with clinical developments [6]. - Payment standards are to be dynamically adjusted, with a focus on collaboration between insurance departments and medical institutions [6]. - Supporting measures are detailed, including provisions for special cases and prepayment mechanisms, reinforcing the commitment to support medical institutions [6][7]. Requirements for Local Healthcare Departments - Local healthcare departments are urged to prioritize the implementation of the disease-based payment reform, optimize policies, and enhance monitoring and evaluation of reform outcomes [8]. - Training and capacity-building initiatives for healthcare staff regarding the new payment methods are emphasized to ensure effective adaptation to the reforms [8].

Core Viewpoint - The stock price of China Resources Medical Holdings has plummeted due to a significant decline in expected mid-year profits, with a forecasted drop of 20% to 25% year-on-year for the six months ending June 30, 2025, and a more severe decline of 55% to 60% when excluding a one-time gain of approximately 210 million yuan [3][5]. Company Performance - China Resources Medical Holdings experienced a stock price drop of 15.58% on August 4, 2023, reaching a market capitalization of 4.85 billion HKD [1]. - The company anticipates a profit decline primarily due to reduced average medical insurance fees affecting operational profits and a gradual exit from the IOT business, which has decreased profit contributions [5]. - The company's hospital business revenue for 2024 has already shown a downward trend, with a reported revenue of 9.185 billion yuan, a year-on-year decrease of 2.4% [8]. Industry Context - The performance of hospital stocks has been generally poor in the first half of the year, with other companies like International Medical and Innovation Medical also forecasting losses [10]. - The National Healthcare Security Administration has introduced a new payment reform (DRG/DIP 2.0), which aims to optimize payment methods and improve service quality, potentially impacting the financial performance of medical institutions [12]. - The DRG/DIP payment model encourages hospitals to focus on clinical treatment efficiency and management, presenting both opportunities and challenges for companies in terms of information management and cost control [12].

Core Viewpoint - The stock price of China Resources Medical Holdings has plummeted due to a significant decline in expected mid-year profits, with a forecasted drop of 20% to 25% year-on-year for the six months ending June 30, 2025 [2][3]. Company Performance - On August 4, China Resources Medical's stock opened down 7% and fell to a low of 3.70 HKD, with a maximum decline exceeding 16%, closing at a 15.58% drop, resulting in a total market capitalization of 4.85 billion HKD [2]. - The company anticipates a profit decline of 55% to 60% year-on-year when excluding a one-time gain of approximately 210 million CNY from the Yanhua IOT agreement [3]. Reasons for Profit Decline - The primary reasons for the profit decline include reduced average medical insurance fees leading to lower operating profits for its medical institutions and a gradual exit from the IOT business, which has decreased profit contributions [5]. - The hospital business revenue has already shown a downward trend, with a reported revenue of 9.185 billion CNY in 2024, a year-on-year decrease of 2.4% [7]. Industry Context - The overall performance of hospital stocks has been poor in the first half of the year, with other companies like International Medical and Innovation Medical also reporting losses [8]. - The National Medical Insurance Administration has introduced reforms to the payment methods, which are expected to impact the industry significantly, pushing for a shift from "drug-supported medical care" to "quality-driven" services [9][10].

Core Viewpoint - The stock price of China Resources Medical Holdings (华润医疗) plummeted significantly after the company issued a profit warning, indicating a projected profit decline of 20% to 25% for the first half of the year, and a more severe drop of 55% to 60% when excluding one-time gains [1][4]. Company Performance - On August 4, the stock price of China Resources Medical fell by 15.58%, closing at HKD 3.74, resulting in a total market capitalization of HKD 48.5 billion [2][3]. - The company expects a profit decline due to reduced average medical insurance fees affecting operational profits and a gradual exit from the IOT (Investment-Operation-Transfer) business, which has decreased profit contributions [1][4]. Financial Metrics - For the full year 2024, China Resources Medical reported revenue of HKD 9.855 billion, a decrease of 2.5% year-on-year, while shareholder profit increased by 119.6% to HKD 566 million, with earnings per share at HKD 0.45 [6]. - The decline in revenue was primarily due to the impact of medical insurance cost control, with outpatient and inpatient average income dropping by 2.4% and 4.3%, respectively [6]. Management Changes - Significant changes in the board of directors occurred on June 19, with Song Qing resigning as executive director and chairman, replaced by Yu Hai, who also serves as the company president [7]. Industry Context - The performance issues faced by China Resources Medical may reflect broader challenges in the private hospital sector, exacerbated by intensified competition and reforms in medical insurance payment methods [9]. - Analysts predict that the implementation of DRG (Diagnosis-Related Group) payment systems will pressure both public and private hospitals, leading to a market shakeout where only those with strong management capabilities will thrive [9].

Core Viewpoint - The "14th Five-Year Plan" emphasizes high-quality development in medical insurance, aiming to enhance public health and support economic growth through comprehensive reforms in the healthcare system [1] Group 1: Medical Insurance Coverage and Reform - During the "14th Five-Year Plan," the basic medical insurance coverage rate is maintained at around 95%, with the number of insured individuals expected to reach 1.327 billion by 2024 [1] - The medical insurance information platform has been fully established, with cross-provincial direct settlement of medical expenses increasing from 5.37 million in 2020 to 23.8 million in 2024, a growth of 44 times [1] - Legislative efforts are ongoing to strengthen the supervision and management of medical insurance funds, with new regulations being implemented [1] Group 2: Payment System Reform - The medical insurance payment system has shifted from "post-payment" to "pre-payment," with over 170 billion yuan pre-paid to medical institutions in 2024 [3] - The settlement cycle has been reduced from 30 working days to no more than 20, with some areas achieving next-day settlements [3] - The annual clearing of medical insurance funds has been expedited, completing six months earlier than at the beginning of the "14th Five-Year Plan" [3] Group 3: Pricing and Service Quality - The National Medical Insurance Administration has introduced pricing guidelines for various medical services, aiming for consistent pricing and comparability across hospitals [4][5] - New pricing projects have been established to encourage high-quality services, such as bedside ultrasound and early infant care [5] - The administration is focusing on industry standards to promote a more regulated and transparent medical market [5] Group 4: Drug Price Management and Innovation - The administration supports pharmaceutical innovation by allowing market-driven pricing for most drugs, with government guidance only for specific categories [6][7] - Since 2018, 10 batches of centralized drug procurement have been conducted, covering 435 types of drugs, which has helped reduce drug prices and improve accessibility [7] - A special governance initiative for drug prices has been launched to standardize pricing for over 27,000 drug specifications [8] Group 5: Reform and Global Cooperation - The medical insurance system promotes both reform and openness, with ongoing efforts to implement successful healthcare models from various regions [9][10] - The administration aims to expand insurance coverage and enhance public awareness through improved mechanisms and digital empowerment [10]

Core Viewpoint - The article discusses the achievements and future plans of China's medical insurance system during the "14th Five-Year Plan" period, highlighting improvements in coverage, fund management, and the introduction of long-term care insurance [1][3]. Group 1: Medical Insurance Coverage - The national basic medical insurance coverage rate remains stable at around 95%, with a cumulative expenditure of 12.13 trillion yuan, averaging an annual growth rate of 9.1% [1][3]. - By 2024, the number of people covered by basic medical insurance is expected to reach 1.327 billion, with long-term care insurance coverage at 190 million [1][3]. - The direct settlement rate for cross-provincial medical expenses exceeds 90%, and the national medical insurance drug list has been unified, totaling 3,159 types of drugs [1][3]. Group 2: Long-Term Care Insurance - The long-term care insurance system is expected to be implemented nationwide soon, as the current pilot programs have shown positive results [4][7]. - As of June 2025, 253 million people are participating in maternity insurance, with cumulative expenditures of 438.3 billion yuan, benefiting 96.14 million people [6]. - The long-term care insurance aims to alleviate the financial burden of daily care for elderly individuals who have lost their ability to care for themselves, addressing the increasing demand for elderly care services [6][7]. Group 3: Fund Management and Regulation - The medical insurance fund is under increasing pressure, and the focus will be on ensuring fund safety and risk assessment during the "15th Five-Year Plan" period [4][8]. - The reform of payment methods has transitioned from a "post-payment" to a "pre-payment" system, promoting efficiency in medical institutions and reducing patient out-of-pocket expenses by approximately 5% year-on-year [9][10]. - The National Medical Insurance Administration has intensified efforts to combat fraud and misuse of medical insurance funds, recovering 16.13 billion yuan in the first half of the year through inspections of 335,000 medical institutions [10][11]. Group 4: Drug Price Governance - The article emphasizes the importance of drug price governance, with the government supporting market-driven pricing while also maintaining oversight to prevent price manipulation [12][13]. - Since 2018, the government has conducted 10 rounds of centralized drug procurement, covering 435 types of drugs, which has helped lower drug prices and improve accessibility [13][14]. - The National Medical Insurance Administration is committed to ensuring fair pricing practices and encourages public reporting of unusually high drug prices [14].

Core Viewpoint - The National Medical Insurance Administration emphasizes the importance of enhancing the quality of medical insurance services during the "14th Five-Year Plan" period, focusing on improving access and affordability for the public [1][3]. Group 1: Medical Insurance Coverage and Expenditure - The national basic medical insurance coverage rate has remained stable at around 95%, with a cumulative expenditure of 12.13 trillion yuan, averaging an annual growth rate of 9.1% [1]. - By 2024, the number of people covered by basic medical insurance is expected to reach 1.327 billion [1]. - Nearly 200 billion medical insurance reimbursements have been enjoyed by approximately 200 million people from 2021 to 2024 [1]. Group 2: Support for Specific Demographics - Measures have been taken to enhance support for the elderly and children, including the establishment of a long-term care insurance system, with 190 million participants by the end of 2024 [2]. - The cumulative expenditure for maternity insurance has reached 438.3 billion yuan, benefiting over 96 million people [2]. Group 3: Reducing Medical Costs - Policies have reduced the financial burden on rural low-income populations by over 650 billion yuan during the "14th Five-Year Plan" [3]. - The long-term care insurance has benefited over 2 million disabled individuals, reducing care service costs by over 50 billion yuan [3]. - Direct settlement for cross-provincial medical treatment has reduced the need for out-of-pocket expenses by 590 billion yuan [3]. Group 4: Technological Advancements in Medical Insurance - A unified national medical insurance information platform has been established, significantly improving management efficiency [4]. - The number of people using medical insurance codes has exceeded 1.236 billion, facilitating direct payment for medical services [4]. - The number of direct settlements for cross-provincial medical treatment has increased from 5.37 million in 2020 to 23.8 million in 2024, a 44-fold increase [4]. Group 5: Fund Management and Security - By the end of 2024, the cumulative balance of the medical insurance fund is expected to reach 3.86 trillion yuan [5]. - The administration has recovered 104.5 billion yuan through enhanced fund management and monitoring [5]. - Innovative regulatory measures have been implemented to combat fraud, including the use of big data analysis to identify irregularities [6]. Group 6: Support for Innovative Drugs - Expenditure on innovative drugs has increased significantly, with spending in 2024 being 3.9 times that of 2020, reflecting an annual growth rate of 40% [8]. - A total of 402 new drugs have been added to the medical insurance catalog since the beginning of the "14th Five-Year Plan" [8]. - The establishment of a commercial health insurance catalog for innovative drugs has seen over 100 drugs submitted for approval [9]. Group 7: Future Directions - The National Medical Insurance Administration aims to continue managing the medical insurance fund effectively while supporting the development of the pharmaceutical industry [9]. - The focus will be on providing efficient, safe, and accessible medical products and services to the public, contributing to the overall health of the nation [9].

Group 1 - The National Medical Insurance Administration (NMIA) has initiated the 11th batch of drug procurement, focusing on optimizing procurement rules while ensuring clinical stability, quality assurance, and preventing price collusion [1][2] - Since 2018, the NMIA has conducted ten batches of centralized procurement covering 435 drug varieties, which has effectively reduced drug prices and improved accessibility for the public [1][2] - The 11th batch aims to include 55 drug varieties across various therapeutic areas, maintaining the principle of excluding new drugs from procurement and aligning with the medical insurance catalog negotiations [2] Group 2 - The NMIA is advancing payment reform during the 14th Five-Year Plan, transitioning from a retrospective payment system to a prospective one, and from project-based payments to disease-based payments [3] - By 2024, the basic medical insurance fund expenditure is projected to reach 2.98 trillion yuan, with a 5% decrease in patient out-of-pocket expenses year-on-year [3] - The NMIA is also enhancing the payment reform by developing version 2.0 of the disease-based payment scheme and establishing supporting mechanisms to promote medical technology innovation [3]

21世纪经济报道记者 贺佳雯 北京报道 在推进科技赋能方面，全国统一的医保信息平台全面建成，医保业务编码标准全国统一，医保智能管理水平显著提升。医保码、移动支付和电子处方全面应 用，群众就医购药更加便捷。跨省异地就医直接结算人次从2020年的537万人次增加到2024年的2.38亿人次，增长了44倍，跨省异地就医住院费用直接结算 率超过了90%。 二是医保支付流程更加高效。近年来，医保基金支出持续稳定增长，不仅为广大参保群众的生命健康提供了坚实保障，也为医疗机构的发展提供了重要支 撑。 在推进协同发展方面，建立多层次医疗保障体系，医保各项改革持续赋能医疗机构和医药产业高质量发展。即时结算、直接结算、同步结算稳步推进。国家 医保药品目录实现了全国统一，目录内药品总数达到了3159种。医保支付方式不断完善。药品、医用耗材集中带量采购常态化制度化运行。医疗服务价格改 革试点有序推进，医疗服务价格动态调整机制全面建立。 南方财经·21世纪经济报道记者提问：深化医保支付方式改革是提高医疗资源使用效率的重要举措。国家医保局如何通过这些改革，引导医疗机构从"规模扩 张"转向"提质增效"，更好地满足人民群众看病就医的需求？ ...