Group 1 - By 2025, the national medical insurance system will continue to improve its functions, with basic insurance coverage stable at 95% and reimbursement rates for employee and resident insurance at approximately 80% and 70% respectively, enhancing public health welfare [1] - In 2025, the reimbursement rate for rural disadvantaged groups will exceed 90%, with all 31 provinces and regions achieving intra-provincial pooling of employee insurance personal accounts and 337 areas realizing inter-provincial pooling [1] - Currently, 95% of pooling areas directly distribute maternity benefits to insured individuals, with 31 provinces including assisted reproductive projects in medical insurance, and 7 provinces achieving "no out-of-pocket" expenses for inpatient childbirth [3] Group 2 - In 2025, 114 new drugs will be added to the medical insurance catalog, and the National Medical Insurance Administration will establish a commercial health insurance innovative drug catalog, including 19 highly innovative drugs that significantly benefit patients [5] - Over the past five years, through big data models and intelligent regulatory subsystems, the medical insurance fund has recovered losses of 9.5 billion yuan, with over 100 billion drug traceability codes collected to combat illegal activities [7] - By 2025, 1.25 billion people will have activated their medical insurance codes for medical treatment and drug purchases, with plans to build the world's largest medical insurance imaging cloud, aiming for nationwide interoperability of imaging data by the end of 2027 [7]

Core Viewpoint - The National Medical Insurance Administration summarized the achievements of the "14th Five-Year Plan" period and outlined key tasks for 2026, emphasizing the importance of healthcare reform and innovation to support public health and economic development [1][2]. Achievements of the "14th Five-Year Plan" - Standardized and unified the medical insurance system, enhancing the mutual assistance and protection functions of medical insurance [5]. - Strengthened the foundation for universal coverage, improving the quality and scope of insurance for flexible employment workers and migrant workers [6]. - Expanded the scope of benefits, with over 90% reimbursement for rural low-income individuals and the inclusion of assisted reproductive projects in insurance coverage [6]. - Optimized the payment mechanism, with 949 new drugs added to the insurance directory, totaling 3,253 drugs [6][7]. - Deepened drug price governance, promoting a unified national market for pharmaceuticals and medical supplies [7]. - Enhanced fund management, recovering approximately 120 billion yuan in misused funds over five years [8]. - Promoted digital empowerment in medical insurance, achieving over 600 million cross-province direct settlements [8]. - Emphasized the importance of party leadership in ensuring the stability and development of the medical insurance sector [8]. Key Tasks for 2026 - Consolidate the achievements of universal coverage and improve the basic medical insurance system [11]. - Support the development of commercial health insurance to create a multi-tiered medical security system [11]. - Strengthen fund management to ensure the safety and rational use of medical insurance funds [12]. - Adapt to population development strategies, promoting maternity and long-term care insurance [12]. - Optimize payment and settlement mechanisms to support the healthy development of the healthcare sector [13]. - Leverage strategic purchasing to support innovation in the pharmaceutical industry [13]. - Promote scientific approaches to medical insurance, enhancing the digital platform for universal coverage [14]. - Continuously improve service management to enhance the quality and efficiency of medical insurance services [14].

Core Viewpoint - The National Medical Insurance Administration emphasizes the importance of digital empowerment in medical insurance management and services during the 14th Five-Year Plan period [1] Group 1: Digital Empowerment in Medical Insurance - The meeting highlighted the goal of advancing digital capabilities in medical insurance to enhance management and service levels [1] - A total of 28 high-frequency medical insurance handling matters will be unified, with 90% expected to be processed online [1] Group 2: Cross-Province Medical Services - Over the past five years, more than 600 million instances of direct settlement for cross-province medical services have occurred, reducing out-of-pocket expenses for the public by 660 billion yuan [1] Group 3: Unified Medical Insurance Information Platform - A nationwide unified medical insurance information platform has been established, processing an average of 28 million settlements daily [1] - A total of 1.25 billion medical insurance codes have been activated, allowing for code scanning in medical treatment and medication purchases [1] Group 4: Medical Imaging Cloud - The construction of a medical imaging cloud has been initiated, with nearly 200 million data entries uploaded from 20 provinces [1]