Core Insights - The National Medical Insurance Administration (NMIA) has announced significant advancements in China's medical insurance system, including the establishment of a comprehensive medical insurance mechanism for outpatient medications for hypertension and diabetes, and the implementation of a payment reform by disease type by 2025 [1][2]. Group 1: Medical Insurance Developments - The total amount of personal account mutual aid in the employee medical insurance system has exceeded 100 billion yuan, benefiting over 780 million people in the past five years [1]. - A long-term mechanism to prevent poverty due to illness has been established, with medical assistance benefiting 1.189 billion people, and over 90% reimbursement for rural disadvantaged groups [1]. - The NMIA aims to achieve "no out-of-pocket" expenses for childbirth within the policy scope by 2026, expanding coverage for maternity insurance and long-term care insurance [3]. Group 2: Payment Reform and Management - By 2025, the NMIA will implement version 2.0 of the disease-based payment scheme, enhancing mechanisms for special cases, advance payments, and negotiation [2]. - All medical insurance regions will conduct real-time settlements, with monthly payment timelines reduced to within 20 working days after application, alleviating financial pressure on medical institutions [2]. - The NMIA plans to release version 3.0 of the disease-based payment grouping scheme in 2026, supporting the clinical use of new drugs and technologies [2]. Group 3: Fraud Prevention and Regulation - Over the past five years, approximately 120 billion yuan has been recovered from fraudulent medical insurance claims, with comprehensive coverage of inspections across all provinces [4][5]. - The NMIA has utilized big data models and intelligent regulatory systems to recover 9.5 billion yuan in fund losses, and has implemented drug traceability measures to combat illegal activities [4]. - In 2026, the NMIA will intensify inspection efforts, focusing on regions with high out-of-pocket rates and ensuring strict penalties for violations [5].