(责任编辑：张紫祎) 通知提出，要强化即时结算机制建设，规范资金拨付机制、强化审核把关机制、完善考核监督机制、健 全风险预警机制。在规范基金拨付方面，通知提出，各省级医保部门指导统筹地区定点医药机构原则上 在次月10日前申报医药费用。各地要进一步规范即时结算流程，利用信息化手段，提高即时结算效率， 压缩结算周期，在定点医药机构申报截止次日起不超过20个工作日拨付结算资金，力争在次月底前拨付 到位。缩短特例单议病例申请审核周期，进一步提高医保基金结算拨付效率。各地可根据当年医保基金 预算、往年医保基金支出等情况，合理确定即时结算拨付比例。 医保基金即时结算改革有助于进一步优化医保基金结算运行管理机制，提高结算效率。国家医保局日前 印发《关于全面推进医保基金即时结算改革扩面提质的通知》，要求2025年底前全国所有统筹地区均需 开展即时结算，2026年底前实现即时结算资金占本地医保基金月结算资金的80%以上，2026年底前开通 即时结算定点医疗机构占比达到80%以上。 ...

通知提出，要强化即时结算机制建设，规范资金拨付机制、强化审核把关机制、完善考核监督机制、健 全风险预警机制。在规范基金拨付方面，通知提出，各省级医保部门指导统筹地区定点医药机构原则上 在次月10日前申报医药费用。各地要进一步规范即时结算流程，利用信息化手段，提高即时结算效率， 压缩结算周期，在定点医药机构申报截止次日起不超过20个工作日拨付结算资金，力争在次月底前拨付 到位。缩短特例单议病例申请审核周期，进一步提高医保基金结算拨付效率。各地可根据当年医保基金 预算、往年医保基金支出等情况，合理确定即时结算拨付比例。 本报北京10月27日电 （记者孙秀艳）医保基金即时结算改革有助于进一步优化医保基金结算运行管理 机制，提高结算效率。国家医保局日前印发《关于全面推进医保基金即时结算改革扩面提质的通知》， 要求2025年底前全国所有统筹地区均需开展即时结算，2026年底前实现即时结算资金占本地医保基金月 结算资金的80%以上，2026年底前开通即时结算定点医疗机构占比达到80%以上。 《 人民日报 》（ 2025年10月28日 11 版） (责编：卫嘉、白宇) ...

通知提出，要强化即时结算机制建设，规范资金拨付机制、强化审核把关机制、完善考核监督机制、健 全风险预警机制。在规范基金拨付方面，通知提出，各省级医保部门指导统筹地区定点医药机构原则上 在次月10日前申报医药费用。各地要进一步规范即时结算流程，利用信息化手段，提高即时结算效率， 压缩结算周期，在定点医药机构申报截止次日起不超过20个工作日拨付结算资金，力争在次月底前拨付 到位。缩短特例单议病例申请审核周期，进一步提高医保基金结算拨付效率。各地可根据当年医保基金 预算、往年医保基金支出等情况，合理确定即时结算拨付比例。 （文章来源：人民日报） 本报北京10月27日电 （记者孙秀艳）医保基金即时结算改革有助于进一步优化医保基金结算运行管理 机制，提高结算效率。国家医保局日前印发《关于全面推进医保基金即时结算改革扩面提质的通知》， 要求2025年底前全国所有统筹地区均需开展即时结算，2026年底前实现即时结算资金占本地医保基金月 结算资金的80%以上，2026年底前开通即时结算定点医疗机构占比达到80%以上。 ...

Core Viewpoint - The National Healthcare Security Administration (NHSA) is accelerating the implementation of instant settlement for medical insurance funds, aiming for nationwide coverage by the end of this year and over 80% of designated medical institutions by the end of next year, which will improve cash flow for medical institutions [1][2]. Group 1: Policy Implementation - The NHSA has issued a notice to promote the instant settlement reform, with a focus on expanding the coverage of regions, funds, and designated medical institutions [1][3]. - By the end of 2025, all regions are required to implement instant settlement, and by the end of 2026, 80% of local medical insurance fund monthly settlement funds should be covered by instant settlement [1][3]. Group 2: Impact on Medical Institutions - The reform aims to alleviate the long-standing issue of slow payment to medical institutions, which typically experience a 40 to 60-day wait for funds after patient discharge [2][3]. - Instant settlement will shorten the payment cycle, allowing medical institutions to have smoother cash flow and invest more in equipment upgrades and talent development, ultimately enhancing patient care [2][3]. Group 3: Operational Efficiency - The NHSA has initiated pilot programs for instant settlement, optimizing processes such as fund settlement list uploads and intelligent reviews to improve efficiency [3]. - The notice emphasizes the need for a standardized fund disbursement mechanism, requiring medical institutions to submit expense claims by the 10th of the following month, with funds disbursed within 20 working days [3].

Core Viewpoint - The National Healthcare Security Administration has announced a comprehensive initiative to advance the reform of instant settlement of medical insurance funds, aiming for nationwide implementation by the end of 2025 [1] Group 1: Reform Objectives - All provincial healthcare departments are required to focus on expanding the coverage of instant settlement reforms across regions, fund scope, and designated medical institutions [1] - By the end of 2026, instant settlement funds should account for over 80% of the monthly settlement funds of local medical insurance funds [1] Group 2: Coverage and Scope - The settlement funds will cover employee medical insurance funds (including maternity insurance) and urban-rural resident medical insurance funds [1] - Regions with conditions may explore including critical illness insurance funds and medical assistance funds in the scope of instant settlement [1] - The funds will cover various medical expenses, including outpatient services, outpatient chronic disease treatment, hospitalization, maternity, and pharmacy purchases [1] Group 3: Future Exploration - There is a gradual exploration of including cross-regional medical expenses in the instant settlement scope [1]

经济观察网 10月16日，国家医疗保障局办公室发布关于全面推进医保基金即时结算改革扩面提质的通 知，2026年底前开通即时结算定点医疗机构占比达到80%以上。推进二级及以上定点医疗机构应纳尽 纳，鼓励一级及未定级定点医疗机构纳入即时结算范围。将符合条件的定点零售药店逐步纳入即时结算 机构范围。 ...

Core Viewpoint - The article highlights the issue of "dual pricing" in pharmacies, where the price of a medication is higher when paid through health insurance compared to cash payments, leading to increased costs for insured individuals and undermining the integrity of the health insurance system [1][2][3] Group 1: Pricing Mechanism - The phenomenon of "dual pricing" results in insured individuals facing higher medication costs, transforming health insurance personal accounts into tools for paying inflated prices [2] - Pharmacies exploit the lack of sensitivity among insured individuals regarding their health insurance accounts, creating a dilemma where consumers feel they lose money regardless of their payment method [1][2] Group 2: Impact on Health Insurance System - The existence of price discrepancies diminishes public trust in the health insurance system, as individuals realize they cannot purchase medications at equivalent prices using their insurance [2] - The practice of "dual pricing" is seen as a means for pharmacies to extract funds from health insurance, potentially leading to fraudulent behaviors and significant leakage of health insurance funds [2] Group 3: Regulatory Recommendations - To address these issues, it is recommended that health insurance authorities establish a dynamic price monitoring mechanism and enhance daily management of designated pharmacies, including increased inspections and penalties for violations [2][3] - The implementation of immediate settlement reforms for health insurance funds is suggested to alleviate financial pressure on pharmacies, thereby reducing the incentive for "dual pricing" practices [3] - A graded management system for designated pharmacies should be established, linking compliance with pricing to health insurance payment limits, rewarding compliant operators while penalizing violators [3]

Group 1 - Fujian Quanzhou has launched an instant settlement model for basic medical insurance funds to improve settlement efficiency and alleviate financial pressure on designated medical institutions [1] - The instant settlement reform establishes an efficient mechanism of "daily payment + monthly settlement" by compressing the settlement cycle and increasing payment frequency [1] Group 2 - Shanghai Pharmaceuticals announced that its subsidiary in Thailand received approval from the Thai FDA for the registration of Pregabalin capsules, which are used to treat various types of neuropathic pain and as an adjunct therapy for epilepsy [3] - Gilead Sciences announced that the FDA approved its injectable HIV-1 capsid inhibitor Yeztugo for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection in adults and adolescents weighing 35 kg or more [4] Group 3 - Haizheng Pharmaceutical plans to establish a joint venture for synthetic biology with its wholly-owned subsidiary, with a registered capital of 350 million yuan, aiming to support the professional and large-scale development of its synthetic biology business [6] - Nuo Vision announced a plan to repurchase shares worth between 5 million and 10 million yuan for employee stock ownership plans, with a repurchase price not exceeding 30 yuan per share [7] - Tiankang Biological's subsidiary Tiankang Pharmaceutical has completed the counseling acceptance for its public stock issuance and listing on the Beijing Stock Exchange [8] Group 4 - Baike Biological received approval from the National Medical Products Administration for clinical trials of its influenza virus split vaccine, which aims to provide new vaccination options for individuals aged 60 and above [10] - Dizhi Pharmaceutical announced the completion of patient enrollment for its global Phase III clinical study of its lung cancer targeted drug, which compares its drug with platinum-based chemotherapy for advanced non-small cell lung cancer [11] Group 5 - The FDA announced the launch of the "Commissioners National Priority Voucher" program to expedite new drug review times from approximately 10-12 months to 1-2 months for eligible companies [12] - Shengnuo Biological expects a net profit increase of 254% to 332% year-on-year for the first half of 2025, driven by strong performance in its peptide raw material business [12]

Core Viewpoint - The implementation of the instant settlement reform for medical insurance funds in China is set to significantly improve the financial operations of hospitals, enhance patient experiences, and promote the collaborative development of the healthcare, medical insurance, and pharmaceutical sectors. Group 1: Reform Overview - In 2024, a unified and improved prepayment system for medical insurance funds will be established at the national level, with a total prepayment scale of 72.3 billion yuan in the first quarter of 2025, addressing the funding pressure faced by hospitals [1] - The instant settlement reform aims to shift from a "post-payment" model to a timely payment system, alleviating the financial burden on hospitals and patients [1][2] - The National Medical Insurance Administration has set a goal for 80% of coordinated regions to achieve instant settlement by 2025, with full coverage expected by 2026 [2] Group 2: Implementation and Impact - As of March 2025, 24 provinces have implemented instant settlement, covering 246,700 designated medical institutions with a total payment amount of 165.7 billion yuan, effectively easing operational pressures on hospitals [2] - Innovative mechanisms in provinces like Anhui and Shandong have significantly reduced payment timelines, enhancing cash flow for medical institutions and improving the overall efficiency of the pharmaceutical industry [3] - The reform allows patients to avoid upfront payments for medical expenses, reducing the time and effort spent on reimbursement processes, thereby improving the overall healthcare experience [3]