医保基金直接结算

Search documents
赋能医药产业创新完善生育保险制度
Zhong Guo Zheng Quan Bao· 2025-08-18 20:14
Group 1: Medical Insurance Development - The National Medical Insurance Administration emphasizes empowering the pharmaceutical industry and implementing measures to support high-quality development of innovative drugs [1][2] - By mid-2025, significant progress is expected in medical insurance, including an increase in the number of insured individuals under maternity insurance to 253 million and total maternity insurance benefits expenditure reaching 67.832 billion [1] - The meeting highlights the need for a comprehensive adjustment of the national medical insurance drug catalog and the establishment of a commercial health insurance innovative drug catalog [2] Group 2: Maternity Insurance and Long-term Care - The meeting encourages regions to include flexible employment workers, migrant workers, and new employment forms in maternity insurance coverage, while also exploring basic service packages for prenatal check-ups [3] - There is a push for the implementation of long-term care insurance, with a focus on planning and supporting long-term care services at the community level [3] - The meeting calls for the integration of long-term care services with commercial insurance products to enhance accessibility and suitability of care [3] Group 3: Digital Transformation in Medical Insurance - The meeting aims to transition the medical insurance system from passive payment to proactive empowerment, focusing on health investment rather than just disease compensation [3] - There is an emphasis on promoting research in disease prediction modeling, pharmacoeconomics, and disease attribution analysis in collaboration with medical institutions and research organizations [3] - The integration of technology in medical insurance is encouraged to foster new medical services, AI health management, and smart elderly care [3]
医药板块爆发,医疗ETF(159828)涨近2%,创业板医药ETF国泰(159377)涨超1%
Sou Hu Cai Jing· 2025-08-07 02:11
Core Insights - The national organization for drug procurement in China is entering a deepening phase, emphasizing principles such as "stabilizing clinical use, ensuring quality, preventing collusion, and countering internal competition" [1] - The 11th batch of centralized procurement rules has been significantly optimized, allowing medical institutions to select recognized brands and requiring lowest-priced companies to justify their pricing and commit to not pricing below cost [1] - This adjustment aims to curb vicious price competition and shift the industry focus from "price wars" to "value wars," benefiting leading companies with stable production capabilities and strong cost control [1] Industry Developments - The National Medical Insurance Administration has initiated price governance for "four same" drugs, standardizing prices for over 27,000 drug specifications, which is expected to further concentrate market share among high-quality leading enterprises [1] - There is an exploration of direct settlement of procurement and national negotiation drug consumables by the medical insurance fund, aiming to reduce the payment cycle for pharmaceutical companies from six months to under 30 days, significantly improving cash flow and overall operational efficiency in the industry [1] Investment Opportunities - Interested investors can consider exposure to the pharmaceutical sector through medical ETFs such as 159828 and the 20% fluctuation-capable ChiNext medical ETF Guotai (159377) [1]
海南创新医保基金结算医药货款省级全域直付
Hai Nan Ri Bao· 2025-07-04 01:20
Core Viewpoint - Hainan Province has innovatively implemented a direct settlement system for medical insurance funds, significantly reducing the payment cycle for pharmaceutical companies from an average of one year to less than 30 days, thereby addressing the long-standing issue of slow payment in the pharmaceutical industry [2][3][4]. Group 1: Direct Settlement Implementation - The direct settlement system allows pharmaceutical companies to receive payments quickly, as demonstrated by a case where a company received 32,691.2 yuan within a month instead of the previous one-year wait [2]. - The initiative has expanded the direct settlement scope to include all drugs and consumables purchased through the provincial medical procurement platform, enhancing the stability of drug supply and meeting public healthcare needs [2][3]. - Since the launch of the online payment system on December 2, 2024, Hainan has directly settled approximately 2.409 billion yuan for 481 pharmaceutical companies, further reducing the average payment cycle to 30 days [4]. Group 2: Financial Relief for Hospitals - To alleviate the financial pressure on hospitals, Hainan has implemented a system of monthly pre-settlement, allowing hospitals to receive 90% of their declared medical expenses the day after submission [6]. - A prepayment management mechanism has been established, enabling eligible hospitals to apply for an additional month's worth of medical expenses on top of the monthly pre-settlement [6]. - The new system simplifies the reconciliation process for hospitals, which previously had to coordinate with 19 different agencies, now only needing to interface with the Hainan Medical Insurance Service Center [6].