海南日报海口12月17日讯(海南日报全媒体记者 马珂)12月16日，记者从海南省医保局获悉，为加 快建立我省长期护理保险制度，我省制定《海南省长期护理保险管理办法(试行)》(以下简称《办 法》)。 《办法》指出，建立居家护理、社区护理、机构护理等护理服务模式，根据失能等级、服务提供方 式等实行差别化待遇保障政策，鼓励使用居家和社区护理服务，支付比例给予适当倾斜。在完善量能筹 资机制、均衡职工和居民缴费责任的基础上，逐步适度均衡待遇水平。 符合条件的参保人员，可根据自身实际选择护理服务模式。如需变更服务方式应提前一个月提出申 请，当月不进行变更。明确按床日、按服务时长(服务包)等不同支付方式的适用范围。 因年老、疾病、伤残等，经医疗机构或康复机构规范诊疗，重度失能状态持续6个月(含)以上的参 保人员，由本人或其委托代理人提出申请。 《办法》还鼓励支持发展专业独立的社会化评估机构，实行定点管理。探索发挥家庭医生、养老服 务师在失能等级评估和服务计划制定中的作用，建立健全评估人员规范化培训机制。 《办法》所称长期护理保险(以下简称长护险)是指因年老、疾病、伤残等导致长期失能的参保人， 享有基本生活照料和与之密切相关 ...

2025养老护理员职业现状调研报告在沪发布，未来五年—— 全国养老护理员缺口超500万 -《报告》预测，未来五年，我国老年人口总量将从3.26亿增至近4亿，照护依赖人口增至4000万以上， 5年净增超过850万人，护理员缺口超500万，其中85%—95%集中于居家社区领域 -上海已通过政策补贴、技能认证、薪酬改革、人才目录等多项举措破解行业发展难题，且取得了阶段 性成果，但全国范围内实现专业化、职业化仍需长期努力 昨天，《2025养老护理员职业现状调查研究报告》(以下简称《报告》)在沪发布。 《报告》基于全国超1.6万余份有效样本数据，围绕从业者基本构成、工作特征、职业诉求、薪酬待遇 等核心维度，系统揭示了当前我国养老护理员队伍职业发展现状。《报告》显示，长期居家护理和机构 照料对专业护理员需求更大，养老护理员对技能提升的需求显著，慢性病护理和沟通交流技能是护理员 的核心需求。 《报告》预测，未来五年，我国老年人口总量将从3.26亿增至近4亿，照护依赖人口增至4000万以上，5 年净增超过850万人，护理员缺口超500万，其中85%—95%集中于居家社区领域。 首都经济贸易大学劳动经济学院副教授王永梅结合三年 ...

Core Insights - The National Medical Insurance Administration (NMIA) has announced significant advancements in China's medical insurance system, including the establishment of a comprehensive medical insurance mechanism for outpatient medications for hypertension and diabetes, and the implementation of a payment reform by disease type by 2025 [1][2]. Group 1: Medical Insurance Developments - The total amount of personal account mutual aid in the employee medical insurance system has exceeded 100 billion yuan, benefiting over 780 million people in the past five years [1]. - A long-term mechanism to prevent poverty due to illness has been established, with medical assistance benefiting 1.189 billion people, and over 90% reimbursement for rural disadvantaged groups [1]. - The NMIA aims to achieve "no out-of-pocket" expenses for childbirth within the policy scope by 2026, expanding coverage for maternity insurance and long-term care insurance [3]. Group 2: Payment Reform and Management - By 2025, the NMIA will implement version 2.0 of the disease-based payment scheme, enhancing mechanisms for special cases, advance payments, and negotiation [2]. - All medical insurance regions will conduct real-time settlements, with monthly payment timelines reduced to within 20 working days after application, alleviating financial pressure on medical institutions [2]. - The NMIA plans to release version 3.0 of the disease-based payment grouping scheme in 2026, supporting the clinical use of new drugs and technologies [2]. Group 3: Fraud Prevention and Regulation - Over the past five years, approximately 120 billion yuan has been recovered from fraudulent medical insurance claims, with comprehensive coverage of inspections across all provinces [4][5]. - The NMIA has utilized big data models and intelligent regulatory systems to recover 9.5 billion yuan in fund losses, and has implemented drug traceability measures to combat illegal activities [4]. - In 2026, the NMIA will intensify inspection efforts, focusing on regions with high out-of-pocket rates and ensuring strict penalties for violations [5].

Group 1 - The National Medical Insurance Administration aims to adapt to population development strategies by promoting maternity insurance and long-term care insurance by 2026 [1] - The initiative includes expanding maternity insurance coverage to flexible employment workers, migrant workers, and new employment forms, with a goal of achieving "no out-of-pocket" expenses for childbirth within the policy scope [1] - Seven provinces, including Jilin, Jiangsu, and Shandong, have already achieved a model where childbirth incurs no costs for insured individuals [1] Group 2 - The administration plans to optimize the medical insurance payment settlement mechanism by 2026, promoting healthy development in the medical sector [2] - A new version of the disease-based payment grouping scheme will be released, supporting the clinical use of new drugs and technologies [2] - The initiative includes enhancing the prepayment of medical insurance funds and exploring quarterly settlements to streamline the payment process [2]

Group 1 - The core viewpoint of the article emphasizes the development of maternity and long-term care insurance in China, aiming for comprehensive coverage and financial support for childbirth by 2026 [1] - The National Medical Insurance Administration plans to include flexible employment workers, migrant workers, and new employment forms in maternity insurance coverage, with a goal of achieving "no out-of-pocket" expenses for childbirth within the policy scope [1] - Recent improvements in hospitalization costs for childbirth have been noted, with provinces like Jilin, Jiangsu, and Shandong leading the way in making childbirth financially accessible [1] Group 2 - By 2026, the optimization of the medical insurance payment settlement mechanism is set to promote healthy development in the medical sector, including the release of a new version of the disease-based payment grouping plan [2] - The administration will implement quarterly or monthly special case reviews to support the clinical use of new drugs and technologies, as well as the treatment of complex severe cases [2] - There will be an emphasis on supporting grassroots medical institutions and promoting tiered diagnosis and treatment, alongside increasing prepayment of medical insurance funds and exploring quarterly settlements [2]

（文章来源：21世纪经济报道） 12月13日，全国医疗保障工作会议在京召开。会议做出最新部署，要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。近年来，我国全面提升住院分娩 医疗费用保障水平，积极推动政策范围内生育医疗费用全额保障。吉林、江苏、山东等7个省份已率先 实现生娃基本不花钱。 ...

Core Viewpoint - The article discusses the recent developments in China's maternity insurance policies, aiming for "no out-of-pocket" expenses for childbirth within the policy scope by next year [3][4]. Group 1: Policy Developments - The National Healthcare Security Administration (NHSA) is accelerating the establishment of a comprehensive maternity insurance system to support the population development strategy [4]. - By 2025, all 31 provinces and regions, including Xinjiang Production and Construction Corps, will include eligible assisted reproductive projects in the insurance coverage [4]. - Seven provinces have already achieved full coverage of hospitalization costs for childbirth within the policy scope, with 95% of coordinated areas directly providing maternity allowances to insured individuals [4]. Group 2: Key Initiatives - The NHSA's eight key tasks for next year include improving the maternity insurance system and expanding coverage to flexible workers, migrant workers, and new employment forms [4][5]. - There is an emphasis on exploring the feasibility of including non-employed urban and rural residents in the maternity insurance coverage [4]. - The NHSA aims to reasonably enhance the coverage level for prenatal examination medical expenses and explore the establishment of a basic service package that includes prenatal examination items to reduce the financial burden on insured individuals [5].

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。 ...

Group 1 - The core viewpoint of the article highlights that the Central Economic Work Conference proposed policies to optimize drug procurement and deepen medical insurance payment reforms, which are expected to boost domestic demand in the pharmaceutical industry and signal a shift towards high-quality development for Chinese pharmaceutical companies [1] - The optimization of drug centralized procurement is aligned with the principle of "anti-involution," aiming to stabilize production and achieve a sustainable balance between affordable pricing and reliable quality in clinical medications [1] - The introduction of a "dual directory" mechanism for medical insurance payment reform is expected to facilitate the inclusion of high-value innovative drugs that are not covered by basic medical insurance, thus supporting innovation while ensuring basic healthcare needs are met [2] Group 2 - The establishment of a national long-term care insurance service project directory is anticipated to standardize long-term care services, enhance service quality, and stabilize the rights of beneficiaries, contributing to the smooth operation of long-term care insurance funds [3]

Core Insights - The first long-term care nurse vocational skills assessment in Shaanxi Province took place in Hanzhong, with 50 candidates passing both theoretical and practical evaluations, marking a significant step towards professionalization and standardization of the long-term care service system in the province [1][2] Group 1: Examination Details - The examination utilized a national unified question bank, focusing on service standards and legal regulations in the theoretical section, while the practical assessment simulated real care scenarios, requiring candidates to complete eight tasks within 45 minutes [1] - Candidates ranged in age from 20 to 60 years, primarily from long-term care service institutions and integrated medical-care facilities in Hanzhong, showcasing a diverse educational background and experience level [1] Group 2: Long-term Care Insurance Impact - Hanzhong City, as a pilot city for long-term care insurance since 2021, has seen 403,900 insured individuals, with 3,938 receiving benefits and a total fund expenditure of 69 million yuan, improving the quality of life for disabled individuals and alleviating family care burdens [2] - The strict practical assessment aims to ensure that long-term care nurses can provide professional services to disabled individuals, with ongoing training and evaluation mechanisms being established to support the profession's development [2]