Core Insights - The Jiangsu provincial medical insurance system aims to implement reforms and achieve a balanced fund operation by the end of the "14th Five-Year Plan" period, with a target of 81.41 million insured individuals and a total expenditure exceeding 1.1 trillion yuan [1][2]. Group 1: Policy and Framework - The provincial government has issued implementation opinions to deepen medical insurance system reforms and established the first special medical insurance plan [2]. - A long-term insurance mechanism has been introduced, including a comprehensive database for individual insurance records and measures to prevent poverty due to illness [2]. - The establishment of a joint regulatory mechanism for medical insurance funds aims to enhance fund security and oversight [2]. Group 2: Fund Management and Safety - The government plans to gradually increase financial subsidies for residents' medical insurance and implement regular inspections and special governance in key areas [2]. - The introduction of DRG/DIP payment reform and the establishment of a unified procurement platform are key breakthroughs in reforming the medical insurance system [2]. Group 3: Information Technology and Public Services - The integration of smart technology in medical insurance services includes the promotion of various payment methods and the establishment of a comprehensive public service system across multiple administrative levels [2]. - A dedicated hotline and streamlined processes for various life events have been implemented to enhance public service convenience [2]. Group 4: Future Directions - By 2026, the medical insurance system will focus on high-quality development, ensuring the sustainability of universal coverage and optimizing service delivery [3]. - The plan includes enhancing the long-term care insurance system and improving the management of medical insurance funds [3]. - The integration of artificial intelligence in the medical insurance process is expected to optimize services and enhance data monitoring [3].

Core Insights - By the end of 2025, the number of basic medical insurance participants in Jiangsu province is expected to reach 81.408 million, maintaining a participation rate of over 95% [1] - During the "14th Five-Year Plan" period, the total expenditure of the medical insurance fund in the province will exceed 1.1 trillion yuan, significantly enhancing the well-being of the population [1] Group 1 - The provincial government has implemented various reforms to strengthen the medical insurance system, including the issuance of the "Implementation Opinions on Deepening Medical Security System Reform" and the establishment of the first medical insurance special plan [1] - A comprehensive "one person, one file" insurance database has been created, achieving city-level coordination and establishing a long-term mechanism to prevent poverty caused by illness [1] - The province has made significant progress in key reforms within the medical insurance sector over the past five years, including the advancement of DRG/DIP payment reform and the establishment of a unified sunshine procurement platform [1] Group 2 - In the next five years, Jiangsu will continue to consolidate the achievements of universal insurance coverage, regulate fund management, and improve the multi-tiered medical insurance system [2] - The province aims to enhance the functions of the maternity insurance system and fully establish a long-term care insurance system, promoting the coordinated development of the "three medicals" [2] - There will be a focus on integrating artificial intelligence with the entire medical insurance process to provide higher quality and more efficient services to the public [2]