三医协同发展

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【省医保局】全省医保重点工作现场推进会议在榆林召开
Shan Xi Ri Bao· 2025-07-18 00:25
Core Insights - The meeting held on July 16 focused on reviewing the performance of the provincial medical insurance system in the first half of the year and planning for the second half [1] Group 1: Performance and Achievements - The provincial medical insurance system has made steady progress in reform, management, and service optimization, with improvements in both quality and efficiency [2] - Key reforms include the implementation of the provincial adjustment fund system, payment method reforms, and the dynamic adjustment of medical service prices [2] - Special initiatives have been effectively carried out, including the rectification of issues in medical insurance fund management and the crackdown on fraudulent activities in the pharmaceutical sector [2] Group 2: Future Focus and Strategies - The provincial medical insurance system aims to enhance the balance between development and safety, improve fund management, and expand the coverage of medical institutions [3] - There is a strong emphasis on integrating medical insurance work into broader development strategies and improving the resilience and efficiency of fund operations [3] - Long-term planning is essential, with a focus on institutional development and optimizing management practices to ensure effective service delivery [3] Group 3: Collaborative Efforts and Innovations - The meeting highlighted the importance of collaboration among various departments and the need for continuous innovation in medical insurance practices [4] - Observations were made at various local facilities to assess innovative practices and their effectiveness in improving medical insurance services [4]
2024年医保基金数据点评:基金运行稳健,“三医”协同发展成效显著
CMS· 2025-07-15 11:35
Investment Rating - The report maintains a "Recommended" rating for the industry, indicating a positive outlook for the industry fundamentals and expectations for the industry index to outperform the benchmark index [4]. Core Insights - The 2024 National Medical Insurance Fund data shows a stable and secure operation, with significant achievements in the "Three Medicals" collaborative development [1][2]. - The total number of insured individuals in basic medical insurance reached 1.327 billion, maintaining a coverage rate of over 95% [2]. - Total revenue for the basic medical insurance fund (including maternity insurance) was 3.49 trillion yuan, a year-on-year increase of 4.2%, while total expenditure was 2.98 trillion yuan, a year-on-year increase of 5.5%, resulting in a spending rate of 85.3% [2][10]. - The fund's surplus for 2024 was 514.9 billion yuan, with a cumulative surplus of 5.31 trillion yuan, indicating overall stable fund operations [2]. Summary by Sections Insurance Coverage - As of the end of 2024, the number of insured individuals in employee basic medical insurance was 379 million, a year-on-year increase of 2.3%, with total revenue of 2.37 trillion yuan (up 3.5%) and total expenditure of 1.91 trillion yuan (up 7.6%) [10]. - The number of insured individuals in urban and rural resident basic medical insurance was 947 million, a year-on-year decrease of 1.6%, with total revenue of 1.12 trillion yuan (up 5.78%) and total expenditure of 1.07 trillion yuan (up 1.9%) [10]. Financial Performance - The employee medical insurance fund had a current surplus of 463 billion yuan and a cumulative surplus of 4.49 trillion yuan, while the urban and rural resident medical insurance fund had a current surplus of 519 billion yuan and a cumulative surplus of 818.3 billion yuan [10]. Market Overview - The industry consists of 466 listed companies with a total market value of 624.84 billion yuan and a circulating market value of 557.31 billion yuan [4]. - The absolute performance of the industry over 1 month, 6 months, and 12 months was 2.2%, 18.3%, and 22.4% respectively, while the relative performance was -1.7%, 13.2%, and 6.7% [6].