这篇社会观察，主要来聊聊全国医保基金有结余，药店、医院却遇资金难题，两相对比，核心症结出在结算和统筹上。 医保"不差钱"，可为啥我总觉得"卡壳"？ 你刷完医保码，在系统里这笔账是记上了，可钱并不会立马到药店账上。药店得等着医保局审核，审核通过了，这笔钱才算真正到手。听着是不是有点 像"打白条"？江浙沪那块儿，算是效率高的，大概45天内能到账。可到了河南、湖北这些地方，等上3个月那都是家常便饭。 你想想药店的日常开销：每个月房租压着，少说也占成本的四分之一，员工工资得发吧，药品从药厂拿货也得付钱吧。这些都是每天都要花出去的真金白 银。如果医保回款一拖就是好几个月，药店手里不就捏着一堆"欠条"，却换不来能周转的现金吗？ 这种情况下，可不就只能靠鼓励现金交易来续命了。更别提，药店接入医保系统，还得额外交3%的第三方手续费。本来卖药利润就薄，这一来二去，简直 是雪上加霜。难怪药店对现金支付"情有独钟"，这都是被逼出来的无奈。 医院的"寒冬"：大医院人满为患，基层医院却在倒闭 去药店买药，现金付比刷医保便宜，老家医院接连关门，报销还设每日限额。这些让人闹心的事儿，最近不少人都遇到过。可谁能想到，全国医保基金账户 里躺着 ...

Core Viewpoint - The implementation of direct settlement between medical insurance and pharmaceutical companies has raised significant cash flow concerns for hospitals, as the new model alters the traditional payment cycle and may exacerbate existing financial pressures [1][3][5]. Group 1: Cash Flow Anxiety - Hospitals are experiencing heightened cash flow anxiety due to ongoing reforms in medical insurance payment methods and adjustments in medical service pricing, leading to reduced revenues and difficulties in payroll [2][5]. - The transition to direct settlement has caused hospitals to worry about the potential disruption of cash flow, which has historically been a crucial part of their financial stability [3][5]. - The average accounts receivable days for hospitals from pharmaceutical companies is reported to be 152 days, indicating a significant delay in cash inflow [6]. Group 2: Direct and Instant Settlement Policies - The direct settlement policy, which allows local medical insurance departments to settle payments with pharmaceutical companies directly, aims to shorten the payment cycle to within one month [1][3]. - The introduction of the prepayment system by the National Medical Insurance Administration in November 2024 is intended to alleviate cash flow pressures by allowing hospitals to apply for advance payments from the insurance fund [10][11]. - The prepayment system has been criticized for its stringent application requirements, making it difficult for hospitals to access these funds, which were previously more readily available under the old turnover fund system [11][12]. Group 3: Operational Adjustments in Hospitals - Hospitals are adjusting their procurement strategies due to cash flow constraints, often reducing inventory levels to avoid the risk of stockpiling unsold medications [8][10]. - The pressure to maintain timely payments to pharmaceutical companies has led some hospitals to consider taking loans to meet their obligations, which poses compliance risks [17]. - The implementation of daily or weekly settlement trials in some regions has been viewed positively by hospitals, as it provides more immediate cash flow without significantly increasing administrative burdens [25][24]. Group 4: Future Outlook - The goal of achieving instant settlement for medical insurance funds with designated medical institutions is set for 2025, with a target of 80% of regions implementing this by then [23]. - Concerns remain regarding the potential increase in operational workload for hospitals due to more frequent settlements, although initial feedback suggests that the benefits of improved cash flow outweigh these concerns [24][25].

Group 1 - The biopharmaceutical ETF (159657.SZ) has seen a 0.48% increase, with the associated index, Vaccine Biotech (980015.SZ), rising by 0.53% [1] - Major constituent stocks such as Changchun High-tech, Fosun Pharma, and Tigermed have shown positive performance, with increases of 1.11%, 0.88%, and 4.91% respectively [1] - The National Healthcare Security Administration reports that 77% of coordinated areas have achieved instant settlement between medical insurance and medical institutions, with a total of 300.1 billion yuan allocated to cover 361,800 designated medical institutions [1] Group 2 - Guotai Junan Securities indicates that the vaccine industry will experience a significant increase in inventory in 2024, influenced by demand fluctuations and channel inventory adjustments [2] - The overall sentiment in the vaccine sector is under pressure due to centralized procurement policies and regional political factors [2] - The industry strategy report from Guoxin Securities highlights that the NDA/IND applications for innovative drugs remain active, with progress on products like the HPV vaccine potentially supporting industry sentiment [2]