国家医保局日前发布《关于开展个人医保云建设试点申报工作的通知》(以下简称《通知》)。《通知》 明确，为贯彻落实《国务院关于深入实施"人工智能+"行动的意见》和《国务院办公厅关于加快场景培 育和开放推动新场景大规模应用的实施意见》，创新医保管理工作方式，推动人工智能等新技术在医疗 保障领域的深度融合与有序应用，探索构建覆盖全人群、全周期、全场景的智慧医保管理新范式，决定 开展"个人医保云"建设试点申报工作。 《通知》明确了试点内容。试点地区应紧密围绕总体目标，结合本地数据基础、技术条件和业务需求， 提出具有创新性、可行性的建设方案。重点内容包括但不限于： 《通知》提出，将以全国统一医保信息平台为基础，以数据要素为核心驱动，遵循"要素归集、资源整 合、智能应用、多方赋能"的建设路径，构建省(市)域个人医保云。通过汇聚、治理和应用多维度的个 人医保健康数据，精准绘制包含个人医保健康档案、财务档案、信息档案等的个人医保画像，并将其转 化为参保人可享、可感的智能化服务，为发展新型医疗服务、智慧养老、健康保险等产业提供支撑，为 全国医保数智化发展积累经验。 通过试点，形成一批架构科学、数据鲜活、应用实效显著的个人医保云建 ...

Group 1: Medical Insurance Development - The National Medical Security 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 security, including an increase in the number of people covered by maternity insurance to 253 million and maternity insurance benefit expenditures reaching 67.832 billion yuan in the first half of the year [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] - Long-term care insurance will be fully implemented, with a focus on planning and configuring designated long-term care service institutions and encouraging commercial insurance products that align with long-term care services [3] Group 3: Digital Transformation in Medical Insurance - The meeting calls for a shift in medical insurance from passive payment to active empowerment, focusing on health investment rather than disease compensation [3] - There is an emphasis on integrating medical insurance with technology to promote new medical services, AI health management, and smart elderly care [3]

Group 1: Medical Insurance Development - The National Medical Insurance Bureau emphasizes the need to empower the pharmaceutical industry and implement 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, with expenditures reaching 67.832 billion yuan in the first half of the year [1] - The meeting highlighted the importance of direct settlement of medical expenses for drug procurement enterprises, with an average settlement cycle reduced to within 30 days [1][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] - Long-term care insurance will be comprehensively implemented, with a focus on planning and supporting community-based care services [3] Group 3: Healthcare System Reform - The meeting calls for the reform of medical service pricing and the expansion of immediate settlement of medical insurance funds to healthcare institutions [2] - There is a push for the integration of technology in medical insurance, transitioning from passive payment to proactive empowerment and health investment [3]

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]

Core Insights - The National Medical Insurance Administration held a mid-year meeting on August 15 to summarize the work of medical insurance in the first half of 2025 and to outline key tasks moving forward [1] Group 1: Key Objectives - Empower the development of medical institutions [1] - Foster innovation in the pharmaceutical industry [1] - Ensure the health of the population [1] - Consolidate and expand the basic medical insurance coverage [1] - Improve the maternity insurance system [1] - Fully implement long-term care insurance [1] - Promote standardization in medical insurance [1] - Advance the digitalization of medical insurance [1] - Enhance the scientific approach to medical insurance [1]