转自：贵州日报 金艾 这温度，是"天涯若比邻"的联通。随着跨省异地就医直接结算网络的广泛覆盖与备案手续的不断简化， 曾经繁琐的"跑腿报销"化为历史，距离不再是医保报销的阻隔。 这温度，是"寻常处方"里的减负。门诊共济保障机制的实施，将常见病、多发病的普通门诊费用纳入统 筹基金支付范围。职工医保个人账户的家庭共济，也让家人之间的健康保障更加紧密…… 从村寨到城市，从住院大病到门诊慢特病，从实体卡到"医保码"，医保服务的每一步都朝着更便捷、更 坚实、更温暖的方向迈进。 医保制度改革的温度正悄然融入百姓生活的细节之中。 ...

Core Viewpoint - Guizhou Province has been continuously deepening its medical insurance system reform, focusing on people's health and creating a multi-layered medical security network that covers all citizens, reduces out-of-pocket expenses, and enhances access to healthcare services [4][6]. Group 1: Medical Insurance Reform - The implementation of family pooling for personal medical insurance accounts allows family members, including extended relatives, to share medical expenses, improving the efficiency of insurance fund usage [5]. - The establishment of a comprehensive database for universal insurance coverage has maintained over 41 million insured individuals, with reimbursement rates for inpatient care at approximately 83% for employee insurance and 73% for resident insurance [6]. Group 2: Accessibility and Convenience - The introduction of a "mobile medical insurance station" service model allows village doctors to visit patients at home, facilitating immediate medical insurance settlements [5]. - The integration of artificial cochlear implants into the medical insurance reimbursement system has significantly reduced the cost of the devices from nearly 300,000 yuan to under 50,000 yuan, making them more accessible for families of hearing-impaired children [7]. Group 3: Efficiency in Medical Services - The province has implemented a "one person, one file" system for insurance registration, enhancing the quality and coverage of insurance [6]. - The transition to a prepayment and immediate settlement model for basic medical insurance has reduced the reimbursement processing time from 30 working days to just 1 working day [8]. Group 4: Digital Transformation - The development of a multi-channel, integrated service system for medical insurance has enabled 39.6 million people to activate their insurance codes, with over 10,925 medical institutions offering "face-scan payment" options [10]. - The implementation of a drug traceability system, where each medication has a unique traceability code, has improved transaction efficiency and customer satisfaction in pharmacies [9]. Group 5: Future Directions - The Guizhou medical insurance department plans to continue deepening reforms, enhance the multi-layered insurance system, and promote provincial-level coordination of basic medical insurance to improve the public's sense of security and satisfaction with medical insurance services [10].

齐鲁晚报.齐鲁壹点姜曼 12月25日，记者从"十四五"时期临沂市深化医保制度改革情况介绍新闻发布会上获悉，目前，全市参保居民在基层医疗机构看普通门诊，报销比例为 65%；慢特病种类扩充到81种，其中恶性肿瘤、白血病、尿毒症等多种重大疾病报销比例达到70%；参保居民在定点医院住院发生的政策范围内费用，最 高可报销90%，保障范围和力度进一步加大。 去年8月份国务院办公厅发布《关于健全基本医疗保险参保长效机制的指导意见》，设置参保激励约束机制。中断参保有约束。自2025年起，除新生儿等 特殊群体外，未在集中缴费期参保和中断缴费人员再参保都会有待遇等待期，至少3个月，而且每多断保1年，会增加1个月的待遇等待期。待遇等待期就 是在此期间发生的医疗费用不能报销，也提醒大家"等生病了再交医保"的做法不可取。连续参保有激励。自2025年起，连续参加居民医保满4年，之后每 连续参保1年可提高大病保险最高支付限额3000元；当年没有享受报销且次年正常参保缴费的，次年也可提高大病保险最高支付限额3000元。 参保缴费是享受医保待遇的前提。2026年度居民医保集中缴费期即将于12月31日结束。会上，也提醒广大居民一定要按时参保缴费 ...

Core Viewpoint - The Linyi Municipal Government has made significant progress in enhancing the medical insurance system during the "14th Five-Year Plan" period, focusing on ensuring basic medical coverage, promoting reforms, and improving service quality [2][3][4]. Group 1: Medical Insurance Coverage - The basic medical insurance coverage rate in Linyi has remained stable at over 95%, with a total of 252.51 billion yuan invested by various levels of government to support resident insurance [3][4]. - The reimbursement rates for inpatient expenses under employee and resident medical insurance are maintained at 80% and 65%, respectively [3]. Group 2: Medical Assistance and Support - A total of 348.97 million medical assistance cases were recorded, alleviating medical expenses by 14.51 billion yuan during the "14th Five-Year Plan" period [3]. - The reimbursement standard for insured residents' hospital deliveries has been increased to 3,000 yuan, with a 100% reimbursement rate for insured employees [3]. Group 3: Medical Insurance System Reform - Linyi has implemented a centralized procurement policy for drugs and medical consumables, executing 890 types of procured drugs and 40 categories of medical consumables [4]. - The city has conducted 18 price adjustments for medical service projects, reducing prices for 346 items to ease the financial burden on residents [4]. Group 4: Service Improvement Initiatives - The city has launched a "city-wide handling" initiative for 27 medical insurance services, achieving seamless processing for registration and reimbursement [5]. - The direct settlement rate for medical expenses across provinces has improved to 91.96%, with a total of 4.11 billion yuan disbursed for maternity benefits [5]. Group 5: Fund Management and Efficiency - Over the past five years, the total expenditure of the medical insurance fund reached 795.14 billion yuan, benefiting 2.75 billion people [6]. - The city has implemented a prepayment system for qualified medical institutions, with 39.38 billion yuan disbursed as advance payments during the "14th Five-Year Plan" [6]. Group 6: Regulatory Enhancements - A joint meeting system for medical insurance fund supervision has been established, enhancing the regulatory framework and ensuring accountability [7]. - During the "14th Five-Year Plan" period, the city recovered and refused payments amounting to 10.2 billion yuan due to violations of fund usage [7].

Core Viewpoint - The National Medical Insurance Administration emphasizes the role of the medical insurance fund as a stable financial source for innovation in the pharmaceutical industry, asserting that China will become a global leader in innovative drug development and pricing [1][8]. Group 1: Support for Innovation - The medical insurance system is seen as a driving force for pharmaceutical innovation, with a commitment to support high-quality development in the sector [1][8]. - The total medical insurance expenditure during the 14th Five-Year Plan period is projected to reach approximately 13 trillion RMB, maintaining an annual growth rate of over 10%, which provides substantial funding for industry innovation [2][9]. - The National Medical Insurance Administration has introduced 16 measures to support the high-quality development of innovative drugs, aiming to secure additional resources and development space for these products [3][10]. Group 2: Policy and Regulatory Framework - A comprehensive policy framework has been established, covering drug pricing, procurement, and reimbursement, which supports the entire process of pharmaceutical innovation from product initiation to regulatory evaluation [2][9]. - The dynamic adjustment mechanism for medical service pricing has been implemented, with over 4,600 billion RMB spent on negotiated drugs, leading to sales exceeding 6,000 billion RMB [4][11]. Group 3: Market Mechanisms and Application Scenarios - The National Medical Insurance Administration is actively developing application scenarios based on medical insurance data, including the establishment of a national medical imaging cloud by 2027 to enhance resource utilization and patient convenience [5][12]. - The administration has collected over 90 billion data entries related to drug traceability, ensuring quality and safety throughout the drug lifecycle [5][12]. - New verification scenarios are being established to support the integration of technology and healthcare, including AI-assisted diagnostics and health management systems [6][13]. Group 4: Future Outlook - The National Medical Insurance Administration aims to leverage China's large market, complete industrial system, and rich talent resources to build a diversified payment system and enhance data-driven support for pharmaceutical innovation [7][14].

Group 1 - The U.S. federal government has been in a shutdown for 40 days, with President Trump indicating that a resolution may be near [1] - The Senate is expected to vote on a bill passed by the House, which includes short-term funding measures to sustain the government until January 2026, bundled with three annual appropriations bills [1] - The revised funding proposal still requires approval from the House and President Trump, which may take several days [1] Group 2 - Senate Democrats are resisting the passage of the funding bill to pressure Republicans into agreeing to reforms in the healthcare system, including extending subsidies under the Affordable Care Act [1] - An agreement is being discussed where the Senate will later agree to vote separately on the subsidy issue [1] Group 3 - Financial markets reacted positively, with Nasdaq futures rising by 0.8% and S&P 500 futures increasing by over 0.5% [1] - Bitcoin reached approximately $106,400, while Ethereum rose above $3,600 [1] - Spot gold increased by 0.64% to $4,027, and spot silver rose by 1% [1]

Core Points - The U.S. government has been in a shutdown for 40 days, with President Trump indicating that a resolution may be near [2] - The Senate is expected to vote on a bill passed by the House, which includes a short-term funding measure to finance the government until January 2026, bundled with three annual appropriations bills [2] - The revised funding proposal still requires approval from the House and President Trump, which may take several days [2] - Senate Democrats have been resisting the funding bill to pressure Republicans into agreeing to reforms in the healthcare system, including extending subsidies under the Affordable Care Act [2] - The current agreement under discussion allows for a separate vote on the subsidy issue later [2]

Core Insights - The provincial medical insurance bureau is focusing on addressing public concerns in medical insurance services and is actively reforming the medical insurance system to build a multi-tiered medical insurance framework [1][2][3] Group 1: Long-term Care Insurance - The province has established a long-term care insurance system that integrates urban and rural areas, expanding coverage to include both employed and resident populations, with 55.7 million insured individuals as of August [1] - Seven cities have included rehabilitation assistive device rental fees in long-term care insurance payments, benefiting 3,215 disabled individuals and resulting in over 6.7 million yuan in fund expenditures [1] Group 2: Unemployment Insurance - Policies have been improved for unemployment insurance, allowing the unemployment insurance fund to cover medical insurance contributions for unemployed individuals, facilitating easier access to maternity medical expense reimbursements [2] - The system allows for direct payment of maternity benefits to unemployed individuals' bank accounts after hospital discharge [2] Group 3: Major Illness Insurance - The province is adjusting major illness insurance policies based on the fund's capacity, with pilot programs in four cities to combine resident major illness insurance and employee high-cost medical expense subsidies [2] Group 4: Cross-Region Medical Settlement - The provincial medical insurance bureau is implementing measures to streamline cross-region medical settlements, achieving full coverage for direct settlement of maternity medical expenses across 18 planning areas by the end of July [3] - As of September, 376 medical institutions have been connected for cross-region settlements, with 1,174 cases processed and 6.6 million yuan advanced [3] Group 5: Grassroots Medical Services - The bureau is promoting the distribution of quality and affordable medical services to grassroots levels, with over 33,000 participating units in the collective procurement of medicines, an increase of 4,435 units compared to the end of 2024 [3] Group 6: Efficient Medical Insurance Services - The province has implemented a "one-stop" service model for 27 medical insurance administrative services, allowing residents to access these services at any local medical insurance office without discrimination [4] - An AI customer service system has been launched on the provincial medical insurance bureau's website and social media for continuous support [4]

Core Insights - The healthcare system in China is undergoing significant reforms in 2025, impacting 1.45 billion insured individuals and marking a new phase in the basic medical security system [1] - The core of the reform focuses on optimizing resource allocation to ensure that limited funds benefit those in genuine need, especially in light of the immense pressure on the medical insurance fund [3] Financial Overview - In 2024, the total expenditure of the national medical insurance fund reached 3.2 trillion yuan, an increase of 8.7% year-on-year, while revenue growth was only 6.2%, leading to a substantial funding gap [3] - The new regulations aim to prioritize essential medical services to maintain the long-term stability of the medical insurance fund [3] Key Regulatory Changes - Certain expenses, such as those for special outpatient services and special wards, will no longer be reimbursed, with costs in Beijing for special outpatient services ranging from 300 to 800 yuan, significantly higher than the average outpatient fee of 114 yuan [3] - Non-disease-related medical services, including cosmetic surgeries, are excluded from reimbursement, with the medical beauty market in China reaching 370 billion yuan in 2024, growing at an annual rate of over 15% [3] Specific Cost Restrictions - The reimbursement rate for non-essential drugs has been significantly reduced, with only 2,960 essential drugs fully covered, representing 8.2% of all marketed drugs, impacting chronic disease patients [5] - Non-emergency transfer costs are also restricted, with a 32% unreasonable referral rate in 2024 leading to approximately 25 billion yuan in losses for the insurance fund [5] - Repeated examinations using large medical equipment within 30 days will not be reimbursed after the first instance, with these costs accounting for 7.6% of total insurance expenditures in 2024 [5] Hospitalization and Medical Supplies - Different diseases will have set reasonable hospitalization days, with a 5% reduction in reimbursement for each additional day beyond the limit, aimed at improving resource utilization [7] - High-cost medical supplies will only have basic models fully reimbursed, with patients responsible for the price difference for advanced models, such as a 40% reimbursement for imported knee joint prosthetics [7] Compliance and Awareness - Stricter penalties for fraudulent activities will be implemented, with fines exceeding five times the amount involved, and a blacklist system introduced [5] - Increased awareness of the new regulations among insured individuals can lead to an 8% reduction in unreasonable medical expenditures for every 10% increase in policy knowledge [5] Long-term Outlook - By 2025, the per capita expenditure on the medical insurance fund is projected to be 2,350 yuan, indicating a gap compared to developed countries [8] - The reform aims to optimize resource allocation to ensure more individuals receive necessary medical services, requiring collaboration among the government, medical institutions, and insured individuals for a sustainable healthcare system [8]

Core Viewpoint - The National Healthcare Security Administration (NHSA) has released the "2024 National Medical Security Development Statistical Bulletin," indicating a stable growth in basic medical insurance coverage and a focus on improving service quality and fund management [2][4]. Group 1: Basic Medical Insurance Coverage - As of the end of 2024, approximately 1.327 billion people are enrolled in basic medical insurance in China, maintaining a coverage rate of 95% [4][5]. - The number of employees covered by medical insurance has increased to 379 million, reflecting a 2.3% growth compared to the previous year [5]. Group 2: Fund Revenue and Expenditure - The total revenue and expenditure of the national basic medical insurance fund (including maternity insurance) for 2024 are projected to be approximately CNY 3.49 trillion and CNY 2.98 trillion, respectively [4]. - The employee medical insurance fund revenue is estimated at CNY 2.373 trillion, a 3.5% increase year-on-year, while expenditures are expected to reach CNY 1.910 trillion, marking a 7.6% increase [7][11]. Group 3: Medical Treatment and Benefits - The number of treatment beneficiaries under employee medical insurance is projected to reach 5.308 billion in 2024, a 9.9% increase from the previous year [13]. - The average hospitalization cost for employee medical insurance participants is estimated at CNY 11,707, with varying costs across different levels of medical institutions [15][18]. Group 4: Resident Medical Insurance - By the end of 2024, the number of participants in urban and rural resident medical insurance is expected to reach approximately 947 million [20]. - The revenue for resident medical insurance is projected to be CNY 1.118 trillion, with expenditures of CNY 1.066 trillion, resulting in a cumulative balance of CNY 818.3 billion [21]. Group 5: Maternity Insurance - The number of participants in maternity insurance is expected to reach 25.3 million in 2024, with a 30.2% increase in the number of beneficiaries enjoying maternity benefits [32]. - Maternity insurance fund expenditures are projected to be CNY 140.293 billion, reflecting a 19.2% increase from the previous year [32]. Group 6: Medical Assistance - In 2024, medical assistance expenditures are expected to reach CNY 79.232 billion, providing support to approximately 79.16 million people participating in basic medical insurance [34]. - The average assistance for hospitalization and outpatient services is projected to be CNY 1,254 and CNY 92, respectively [34]. Group 7: Drug and Medical Supply Management - The 2024 National Basic Medical Insurance Drug List includes 3,159 drugs, with 91 new additions this year [38]. - The implementation of centralized procurement for drugs and high-value medical consumables continues, with 62 drugs included in the latest round of procurement [43]. Group 8: Cross-Region Medical Services - In 2024, the total number of cross-region medical visits is expected to reach 397 million, with associated costs of CNY 786.774 billion [44]. - Employee medical insurance accounts for 262 million of these visits, while resident medical insurance accounts for 134 million [44].