央视网消息：2025年，全国医保系统持续完善医保制度功能，优化医保管理服务，基本医保参保率稳定在95%，职工医保、居民医保政策 范围内住院费用报销比例分别稳定在80%和70%左右，有力增进了人民群众的健康福祉。 2025年，114种药品被新增纳入医保目录。国家医保局首次制定商业健康保险创新药品目录，纳入19种创新程度高、患者受益显著的药 品。扎实开展医保基金管理突出问题专项整治，飞行检查实现全国所有省份全覆盖。 国家医疗保障局局长 章轲：5年来通过大数据模型和智能监管子系统，挽回基金损失95亿元。我们创新地开展了药品追溯码采集和监管应 用，累计归集追溯码超1000亿条，有力打击了通过倒卖回流药骗取医保基金等违法违规行为。 2025年，我国大力推进医保数智赋能，累计12.5亿人激活医保码并实现刷码就医购药。建设全球规模最大的医保影像云，力争2027年底前 基本实现CT、X光等影像资料全国互通互认。 2025年，我国巩固提升医保待遇保障水平，农村困难群众政策范围内报销比例超90%。31个省（区、市）及新疆生产建设兵团均已实现职 工医保个人账户省内共济，337个统筹地区实现跨省共济。 目前，全国95%的统筹区将生育 ...

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].

每经AI快讯，据国家医保局消息，12月13日，全国医疗保障工作会议在北京召开。会议指出，"十四 五"时期，推进医保数智赋能，有效提升医保管理服务水平。统一28项高频医保经办事项，9成实现线上 办理。5年来跨省异地就医直接结算超6亿人次，减少群众垫付6600亿元。建成全国统一的医保信息平 台，日均结算量2800万人次，累计12.5亿人激活医保码并实现刷码就医购药。建设医保影像云，20个省 份上传数据近2亿条。 ...