Core Viewpoint - The article discusses the advancements and future plans of China's medical insurance system during the "14th Five-Year Plan" and the upcoming "15th Five-Year Plan," emphasizing the need for equitable access, improved quality, and efficiency in healthcare services [3][4]. Group 1: Achievements During the "14th Five-Year Plan" - The basic medical insurance coverage rate remained stable at around 95%, with nearly 200 billion medical reimbursements enjoyed by the public over four years [5][6]. - The per capita government subsidy for residents' insurance increased from 490 yuan in 2018 to 670 yuan in 2024, with rural low-income and poverty alleviation populations maintaining a coverage rate above 99% [5][6]. - By 2024, the number of insured individuals reached 1.327 billion, with medical assistance benefiting approximately 80 million people annually [5][6]. - The total expenditure of the medical insurance fund reached 12.13 trillion yuan during this period, with an average annual growth rate of 9.1% [11]. Group 2: Innovations and Reforms - The "14th Five-Year Plan" saw significant reforms in medical insurance, including the introduction of a multi-tiered medical security system and the establishment of a dynamic adjustment mechanism for the medical insurance drug list [8][9]. - The number of drugs added to the insurance list reached 402 since the beginning of the "14th Five-Year Plan," with 2.8 billion reimbursements for negotiated drugs in 2024 [9][11]. - The implementation of a long-term care insurance system has expanded, with over 8,800 designated service institutions and 300,000 care service personnel, marking a growth of over 50% since the start of the "14th Five-Year Plan" [13]. Group 3: Future Directions for the "15th Five-Year Plan" - The upcoming "15th Five-Year Plan" aims to enhance the medical insurance system to support common prosperity and adapt to high-quality development needs, balancing fairness and efficiency [3][5]. - The focus will be on expanding coverage for flexible employment workers, addressing gaps in the current insurance system [6][7]. - The integration of new technologies and digitalization will be emphasized to improve the efficiency and accessibility of healthcare services [6][12].

Core Insights - The upcoming "Fifteen Five" period aims to enhance the national medical insurance system to achieve common prosperity and support the development of new productive forces [1][9] - The "Fourteen Five" period has seen significant improvements in medical insurance coverage, with a stable participation rate of around 95% and nearly 200 billion medical reimbursements enjoyed by the public [2][9] Medical Insurance Coverage - By 2024, the national basic medical insurance enrollment is projected to reach 1.327 billion, with annual financial subsidies for residents increasing from 490 yuan in 2018 to 670 yuan [2] - The long-term care insurance pilot program has expanded, covering 190 million people, and the proportion of fund payments for inpatient expenses remains stable at 80% for employees and 70% for residents [2][3] Technological Integration and Employment - The rise of new employment forms, particularly flexible employment, presents challenges for the current medical insurance system, with approximately 200 million urban workers still lacking basic insurance [3][4] - Local governments are exploring pathways for new employment forms to participate in basic medical insurance, with initiatives to encourage platform companies to enroll their workers [4] Fund Management and Expenditure - Since the establishment of the National Medical Insurance Bureau, the cumulative expenditure of the medical insurance fund has reached 12.13 trillion yuan, with an average annual growth rate of 9.1% [9] - The expenditure on newly negotiated drugs has significantly increased, with 2024 spending being 3.9 times that of 2020, reflecting a 40% annual growth rate [9] Cost Control and Efficiency - The total medical expenses for insured employees in 2024 are estimated at 2.06 trillion yuan, a 3.6% increase from the previous year, while resident medical expenses are projected at 2.03 trillion yuan, up 3.7% [7] - The reforms in medical insurance payment methods and the strengthening of fund supervision have contributed to a reduction in personal medical expenses by approximately 5% year-on-year [6][7] Long-term Care Insurance Development - The long-term care insurance system has attracted over 50 billion yuan in social capital investment during the "Fourteen Five" period, with more than 8,800 service institutions established [11] - A nationwide unified long-term care insurance system is expected to be launched within the year, aiming to provide stable funding support for the elderly care and health industries [11]

Group 1 - The core viewpoint emphasizes the dual role of medical insurance in promoting common prosperity and providing institutional support for the development of new productive forces during the "15th Five-Year Plan" period [1][9] - The national medical insurance coverage reached 1.327 billion people, with a stable basic medical insurance participation rate of around 95% during the "14th Five-Year Plan" period, benefiting nearly 20 billion medical reimbursements [2][9] - The government aims to balance fairness and efficiency in medical insurance development, adapting to high-quality development needs through institutional innovation [1][2] Group 2 - The per capita financial subsidy for residents' insurance contributions increased from 490 yuan in 2018 to 670 yuan in 2024, with rural low-income and poverty alleviation populations maintaining a participation rate of over 99% [2] - The total medical insurance expenditure reached 12.13 trillion yuan during the "14th Five-Year Plan," with an average annual growth rate of 9.1% [9] - The medical insurance fund's expenditure on newly negotiated drugs increased significantly, with 2024 spending being 3.9 times that of 2020, reflecting a 40% annual growth rate [9] Group 3 - The number of designated medical institutions for medical insurance is expected to reach 1.1 million by June 2025, with cross-provincial direct settlement for outpatient chronic diseases expanding to 10 types [3] - Approximately 200 million urban employees are still not covered by basic medical insurance, highlighting a gap in coverage for flexible employment [3][4] - Local medical insurance bureaus are exploring pathways for new employment forms to participate in basic medical insurance, with various strategies being implemented [4] Group 4 - The medical insurance fund's total expenses for employees and residents are projected to grow at a slower rate, with 2024 medical expenses for employee insurance at approximately 2.06 trillion yuan, a 3.6% increase from the previous year [7] - The implementation of a multi-tiered payment system for major diseases is necessary to reduce the high personal payment ratio, which can lead to financial hardship for families [8] - The focus on long-term care insurance is expected to stabilize funding for related industries, with over 50% growth in service institutions and personnel during the "14th Five-Year Plan" [11]