我妈妈前段时间在医院住了一个星期，出院的时候拿到账单，本来想着有医保，自己不用掏太多钱。结果算下来，有些项目医保根本不给报销，自己得全部 自费。那天我陪她拿着账单去咨询医保科的工作人员，才明白原来有很多项目是医保规定不能报的。工作人员很耐心地给我们讲解了哪些是医保不报的范 围，我们这才恍然大悟。其实这些规定可能很多人都不知道，等到真正用医保的时候才会发现，结果就得自己掏钱。 在我们身边，有多少人都交了医保，却对医保具体能报什么、不能报什么并不十分清楚。有的人以为交了医保，去医院看病就什么都能报。有的人经历过几 次就慢慢明白了，有的人到现在还在吃亏。最近医保又有了一些新的调整，更加明确了哪些费用是不能报销的。这对于我们每个参保的人来说，都是需要提 前知道的，这样才能在看病的时候做好准备。 医保制度的出发点是什么呢？是为了让普通老百姓能够看得起病，减轻医疗费用的负担。但医保基金是有限的，每年的收入就那么多，要支撑全国这么多参 保人的医疗费用，就必须要有一定的规范和限制。哪些费用必须报，哪些费用不能报，这个规定就是为了确保医保基金能够用在最需要的地方。理解了这一 点，我们就能更加理性地看待医保的规定，而不是觉得为什 ...

Core Viewpoint - The implementation of cross-provincial direct settlement for medical expenses has significantly improved the healthcare experience for the public, reducing the financial burden and enhancing accessibility [1] Group 1: Policy Impact - During the "14th Five-Year Plan" period, the number of outpatient chronic special diseases eligible for cross-provincial direct settlement increased from zero to 10 [1] - The cross-provincial hospitalization direct settlement rate has reached approximately 90% [1] - Cumulatively, the cross-provincial direct settlement has reduced the upfront costs for insured individuals by 590 billion yuan [1] Group 2: Public Sentiment - The positive feedback from ordinary citizens, such as Wang Zhongyun, highlights the tangible benefits of the policy, showcasing a strong sense of satisfaction among the public [1] - The perceived value of the policy is reflected in the significant improvement in the public's healthcare experience, emphasizing the importance of addressing the needs of the people [1] Group 3: Future Focus - Looking ahead to the "15th Five-Year Plan," the focus will remain on addressing the challenges faced by the public during the medical process, with an aim to continuously improve the healthcare system [1] - The goal is to strengthen the health security of the populace through an increasingly robust medical insurance system [1]

Group 1 - The core viewpoint of the report indicates that the Chinese medical security system continues to improve, with enhanced benefits for the public, stable fund operations, and improved management services [1] Group 2 - As of the end of last year, approximately 1.327 billion people were covered by basic medical insurance, maintaining a coverage rate of over 95%. The total income of the basic medical insurance fund was 3.491337 trillion yuan, while total expenditures were 2.976403 trillion yuan [2] - The number of insured employees reached 37.94834 million, while the number of insured urban and rural residents was 94.71373 million. The average hospitalization cost for insured employees was 11,707 yuan, with a fund payment ratio of 84.8% [2] - The medical expenses for insured residents amounted to 2.031216 trillion yuan, reflecting a year-on-year growth of 3.7%. The number of treatment instances for insured residents was 3.035 billion, increasing by 14.9% [2] Group 3 - Over 90% of discharged patients were covered under the disease-based payment system, with approximately 80% of the fund expenditures for eligible inpatient medical insurance being allocated to this system [3] - Since the establishment of the National Medical Insurance Administration, the cumulative expenditure of the medical insurance fund has reached 16.48 trillion yuan, with an average annual growth rate of 11% [3] - From 2018 to 2024, the sales revenue of newly negotiated drugs during the agreement period exceeded 540 billion yuan, with medical insurance fund expenditures surpassing 370 billion yuan [3] Group 4 - Approximately 253 million people participated in maternity insurance, with fund expenditures reaching 140.293 billion yuan, a year-on-year increase of 19.2% [4] - The long-term care insurance pilot program is progressing steadily, with 18.78634 million participants in 49 pilot cities and 146,250 individuals receiving benefits [4] Group 5 - Last year, there were 397 million instances of outpatient and inpatient care, with medical expenses totaling 786.774 billion yuan. The medical insurance system recovered 27.5 billion yuan through intelligent supervision, saving 3.1 billion yuan in losses [5] - The National Medical Insurance Administration conducted 64 inspection groups, checking 506 designated medical institutions, and awarded 754 individuals for reporting, totaling 1.866 million yuan in rewards [5]