从织密全球最大医保网络，到破解失能人群照护难题；从优化生育保障链条，到加速新药好药普惠可及；从深化支付方式改革，到筑牢基金监 管防线，"十四五"时期，我国医保基金稳健运行，夯实保障根基；集采改革持续深化，药品价格合理回归；服务网络不断下沉，"家门口"便捷 医保服务越走越近…… 这张更加公平、更加持续、更有效率的全民医保网，筑就更加坚实的"健康中国"底盘。跟随海报，共同感受大国医保如何撑起全民健康守护 伞，让"病有所医"化作亿万群众触手可及的获得感、幸福感与安全感。 "十四五"期间，全国基本医保参保率稳定在95%左右 � · 2024年度全国基本医保参保人数达到13.27亿人 ● 职工和居民住院费用目录内基金支付比例 稳定在80%和70%左右 · 截至2024年底，医保统筹基金累计结余3.86万亿元 新华丽 最大期期 il · 出台失能等级评估、服务机构管理、长期照护师等15个文件 · 长期护理保险定点服务机构超过了8800家 新华社 ST BERE NT 177 11:14 护理服务人员达到30万人 · 长期护理保险制度试点深入推进，参保覆盖达1.9亿人 · "十四五"期间累计惠及超过200万失能群众 减轻群 ...

5年来，国家医保局加大基金使用监管力度，通过大数据模型和智能监管挽回基金损失95亿元。目 前药品追溯码已累计归集超1000亿条，有力地打击了违法违规行为。 明年，国家医保局将通过医保基金预付、即时结算等支付改革赋能医药机构高质量发展，同时持续 加大对医药产业创新发展的支持力度。 国家医保局数据显示，"十四五"期间，医保基金累计支出超13万亿元，惠及近200亿就诊人次；全 国生育保险的参保人数达到2.55亿人，近95%的统筹区将生育津贴直接发放给个人。国家医保局局长章 轲透露，5年来，国家组织药品和高值医用耗材集采已经覆盖糖尿病、肿瘤、感染等常见病用药和人工 关节、人工晶体、人工耳蜗等高值医用耗材。与此同时，跨省直接结算范围扩大，职工医保个人账户共 济范围拓宽至近亲属等举措落地。 章轲：5年来跨省异地就医直接结算服务超6亿人次，减少了群众的垫付超6600亿元。医保信息平台 接入了超100万家定点医药机构，日均结算超过了2800万人次，累计12.5亿人激活了医保码，并实现了 刷码就医购药。 央广网北京12月14日消息（记者杜希萌 孙永）据中央广播电视总台中国之声《新闻和报纸摘要》 报道，国家医保局13日透露，"十 ...

2025年，国家医保局制定实施按病种付费方案2.0版，完善特例单议、预付金、协商谈判等配套机制。 各地全面开展医保数据定向发布，定期向医疗机构"亮医保家底"。完善结算管理机制，全国所有统筹地 区开展即时结算，月度拨付时限逐步压缩至申报后20个工作日内，许多统筹地区时限次日结算，有效缓 解医疗机构垫资压力。按病种付费已覆盖所有医保统筹地区，特例单议规则更加完善，有效解除了医疗 机构收治危重病人，使用新药新技术的后顾之忧。 2026年，国家医保局将发布按病种付费3.0版分组方案。全面推行按季或按月特例单议评审，支持新药 耗新技术临床使用和疑难重症救治。加大医保基金预付力度，全面推进医保基金即时结算，探索按季度 清算。全面完成40批立项指南编制工作，实现医疗服务价格项目全国基本统一。 据央视新闻，12月13日，全国医疗保障工作会议在北京召开，国家医保局在会议上发布多项数据和措 施。 全国职工医保个人账户共济金额超1000亿元 记者今天从全国医疗保障工作会议获悉，近年来，我国不断提升医保待遇保障水平，全国各省份均已实 现职工医保个人账户省内共济，337个医保统筹地区实现跨省共济。5年来，个账共济超7.8亿人次，共 济 ...

Core Viewpoint - The National Medical Insurance Administration summarized the achievements of the "14th Five-Year Plan" period and outlined key tasks for 2026, emphasizing the importance of healthcare reform and innovation to support public health and economic development [1][2]. Achievements of the "14th Five-Year Plan" - Standardized and unified the medical insurance system, enhancing the mutual assistance and protection functions of medical insurance [5]. - Strengthened the foundation for universal coverage, improving the quality and scope of insurance for flexible employment workers and migrant workers [6]. - Expanded the scope of benefits, with over 90% reimbursement for rural low-income individuals and the inclusion of assisted reproductive projects in insurance coverage [6]. - Optimized the payment mechanism, with 949 new drugs added to the insurance directory, totaling 3,253 drugs [6][7]. - Deepened drug price governance, promoting a unified national market for pharmaceuticals and medical supplies [7]. - Enhanced fund management, recovering approximately 120 billion yuan in misused funds over five years [8]. - Promoted digital empowerment in medical insurance, achieving over 600 million cross-province direct settlements [8]. - Emphasized the importance of party leadership in ensuring the stability and development of the medical insurance sector [8]. Key Tasks for 2026 - Consolidate the achievements of universal coverage and improve the basic medical insurance system [11]. - Support the development of commercial health insurance to create a multi-tiered medical security system [11]. - Strengthen fund management to ensure the safety and rational use of medical insurance funds [12]. - Adapt to population development strategies, promoting maternity and long-term care insurance [12]. - Optimize payment and settlement mechanisms to support the healthy development of the healthcare sector [13]. - Leverage strategic purchasing to support innovation in the pharmaceutical industry [13]. - Promote scientific approaches to medical insurance, enhancing the digital platform for universal coverage [14]. - Continuously improve service management to enhance the quality and efficiency of medical insurance services [14].

每经AI快讯，据国家医保局消息，12月13日，全国医疗保障工作会议在北京召开。会议要求，2026年 各级医保部门要深入推进医保改革，积极推进科技创新。积极适应人口发展战略，推动生育保险和长期 护理保险发展。推动将灵活就业人员、农民工、新就业形态人员纳入生育保险覆盖范围。合理提升产前 检查医疗费用保障水平，力争全国基本实现政策范围内分娩个人"无自付"。将适宜的分娩镇痛项目按程 序纳入基金支付范围。全面实现生育津贴按程序直接发放给参保人。全面推进长期护理保险制度，优化 长护服务供给。鼓励商保机构开发商业长期护理保险产品。 ...

中新网长春12月5日电 (记者 郭佳)位于长春市净月大街旁的吉林心脏病医院外观并不起眼，没有豪华的 大厅，也没有炫目的广告，院长黄海甚至没有一间像样的办公室。但就是这家医院发起的"吉心工程"， 让3万余名贫困心脏病患者获得免费救治。 "我们做的不仅是一所医院的事，而是在探索一种无偿救助的机制。"黄海常说。 10月17日，吉林长春，黄海(左三)与外国医生交流。张瑶 摄 从"生命之光"到"吉心工程" 时间回到2004年，吉林心脏病医院刚刚成立。当时，中国心脏病患者为数众多，农村地区"治病难、治 病贵"的问题尤为突出。黄海意识到，如果医疗完全按照市场逻辑运转，许多贫困患者将永远无力负担 治疗费用。 2005年，他与吉林省慈善总会合作，启动了"生命之光"项目——医院减免部分费用，慈善机构承担一部 分，患者只需8000元即可接受手术。这一模式在经济欠发达地区迅速推广。到2014年，项目升级为"吉 心工程"，救助范围从儿童扩大到所有贫困心脏病患者，彻底实行全免费手术。 为了让患者得到高质量的治疗，2013年以来，黄海引进数十位欧美心脏外科专家全职加盟。目前，医院 的冠脉分叉病变改良技术已被纳入欧洲心脏病学会(ESC)推荐 ...

Core Insights - The conference focused on the challenges and opportunities presented by the deepening national medical insurance reform, discussing innovative paths for high-quality hospital development [1][2] - Over 140 representatives from various medical institutions attended, indicating strong engagement from the healthcare community [1] - Experts provided insights on payment reform, hospital operation management, and the collaborative development of medical insurance and healthcare [1] Group 1 - The conference was hosted by Weifang People's Hospital and included key figures such as the hospital's president and vice presidents [1] - Notable experts from both national and provincial levels were invited to share their knowledge and experiences [1] - The discussion segment featured representatives from various hospitals sharing successful experiences and innovative practices regarding current medical insurance reform challenges [1] Group 2 - The annual meeting was described as a high-level academic event aimed at building consensus and looking towards the future of the industry [2] - Weifang People's Hospital, as the main unit, expressed commitment to collaborating with member units to enhance medical insurance management in the city [2] - The goal is to provide better quality and more efficient medical services to insured individuals [2]

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]

Core Insights - The article discusses the impact of healthcare policy reforms on chronic disease patients in China, highlighting the balance between personal account reductions and increased social insurance coverage [1][4][6] Group 1: Policy Changes and Their Effects - The healthcare policy in Jilin Province has undergone three adjustments from 2023 to 2025, significantly reducing out-of-pocket expenses for chronic disease medications [1][4] - The monthly contributions to personal accounts for retirees have decreased from 240 yuan in 2022 to 111 yuan in 2023, and further to 78 yuan in 2024, reflecting a shift towards increased reimbursement rates [2][3] - New outpatient reimbursement policies have been introduced, increasing reimbursement rates by 5% and lowering the threshold for chronic disease patients, thus enhancing financial support for those with chronic conditions [3][4] Group 2: Financial Implications for Patients - Patients like Zhang Guilan and Li Hongmei have reported reduced personal expenses due to the new reimbursement policies, despite lower personal account contributions [3][5] - The introduction of a "public servant medical subsidy" in 2025 aims to provide additional support for retired civil servants, reflecting a targeted approach to healthcare funding [4][6] - The overall trend indicates a move from individual account reliance to a more collective insurance model, enhancing the mutual support capacity of the healthcare system [4][6] Group 3: Broader Implications for Healthcare Access - The reforms aim to address the inequities in healthcare access between urban and rural areas, with improvements in the availability of essential medications in rural health facilities [8][12] - The introduction of chronic disease certificates has significantly reduced medication costs for patients, demonstrating the effectiveness of policy in alleviating financial burdens [9][10] - Future reforms are expected to further expand coverage for chronic diseases and improve the efficiency of the reimbursement process, indicating a commitment to enhancing healthcare access for all [11][12]

Core Viewpoint - The article clarifies that recent rumors about the cancellation of personal health insurance accounts and full reimbursement for hospital stays are false. The core of the health insurance reform is to make spending more efficient and beneficial for a larger number of people, rather than misleading the public with unrealistic promises [1][8]. Summary by Sections Reasons for Reform - The health insurance fund is under increasing pressure due to a growing elderly population, with nearly one-fourth of the total population aged 60 and above. This demographic tends to incur higher medical expenses, leading to a mismatch between fixed income from contributions and rising expenditures [3]. - Previous issues included inequitable use of personal accounts, where higher earners accumulated more funds while lower earners struggled to access necessary care. This created a disparity in healthcare access [3]. - The health insurance fund's total revenue for 2024 is projected at 2.8 trillion, with expenditures at 2.6 trillion, indicating a slowing growth rate and potential future sustainability issues [3]. Changes in Personal Accounts - The reform reallocates a portion of funds from personal accounts to a collective pool, increasing reimbursement rates for outpatient services from 50% to 75%. This aims to encourage visits to community hospitals rather than overcrowded major hospitals [5]. - Personal accounts will still exist but can now be used by family members, enhancing convenience for households with elderly or children [5]. Impact on Healthcare Access - The reform addresses the imbalance where major hospitals are overcrowded while smaller clinics remain underutilized. By increasing reimbursement rates for community hospitals, patients are incentivized to seek care there, allowing major hospitals to focus on more serious cases [5]. - Concerns about increased personal costs are mitigated by the fact that higher reimbursement rates for outpatient services will lead to overall savings, even if personal account balances decrease [5]. Hospital Efficiency - Hospitals are now incentivized to manage costs more effectively, as they will receive a bundled payment for treatments rather than being rewarded for excessive tests and medications. This is expected to reduce unnecessary expenses for patients [6]. Overall Goals of Reform - The ultimate aim of the health insurance reform is to create a healthier fund that allows more people to afford quality healthcare. It is not about eliminating personal accounts or achieving full reimbursement but rather ensuring that resources are allocated more equitably and effectively [8].