21点评：作为健全全民医保制度的核心举措，基本医疗保险省级统筹的全面推进，是强化医保基金互助 共济功能、提升制度保障韧性的必然要求。自国务院常务会议此前专项部署相关工作后，地方层面已进 入实质性落地实施阶段，统筹进度与实施成效正成为衡量区域医保制度完善程度的重要指标。 这里是《21健讯Daily》，欢迎与21世纪经济报道新健康团队共同关注医药健康行业最新事件！ 政策动向 湖南出台实施方案，推动基本医保省级统筹 1月15日，据国家医保局消息，为贯彻落实国家部署，湖南省人民政府办公厅近日印发《关于推进基本 医疗保险省级统筹的实施方案》，旨在通过统一政策、统筹基金、强化管理，提升全省医疗保障水平与 基金抗风险能力。方案明确了主要任务与分步实施的时间表，计划到2029年基本实现省级统筹。 具体而言，2026年底前，市州全面做实基本医保市级统筹。统一全省主要医保政策。健全基本医保省级 统筹配套管理制度，完善基金运行风险监测预警机制。2027年，启动实施基本医保省级统筹。先启动职 工医保省级统筹，2028年底前启动居民医保省级统筹。到2029年，基本实现基本医保省级统筹，政策更 加规范，基金更加安全，群众医疗保障更加有力 ...

转自：扬子晚报 2026年医保省级统筹提速，将对普通人的求医问药带来哪些影响？ 第一财经采访的专家表示，医保省级统筹是让绝大多数参保人受益的改革，它赋予了参保人更大的就医 自主权、更公平的待遇保障、更便捷的经办服务，但对于医疗机构来说则是机遇和挑战并存，三级医院 的"虹吸效应"可能会加剧，这对医疗机构自身能力的提升以及医保基金的监管提出了更高要求。 2026年，医保省级统筹加速之年 基本医保省级统筹可以扩大医保基金共济范围、提高医保基金抵御风险能力，同时也是提升医保基金治 理水平的举措。 从1994年职工医保改革的"两江试点"（江西九江、江苏镇江）算起，长期以来，中国的医保是以县级统 筹为主，医保基金的资金池建立在县里，这导致各地在筹资水平、待遇标准、支付方式和预算管理等各 不相同，医保制度出现严重碎片化。 "推进基本医疗保险省级统筹"已明确写入"十五五"规划建议之中。2026年，我国将在全面做实市地级统 筹的基础上，稳步推进基本医保省级统筹。 国务院常务会议日前对推进省级统筹作出了进一步的部署。目前，全国已有20个省份发文推进省级统 筹。 从地方实施的省级统筹模式看，主要是两种：一是统收统支的模式，即全省（ ...

2025.12. 31 本文字数：2208，阅读时长大约4分钟 基本医保省级统筹可以扩大医保基金共济范围、提高医保基金抵御风险能力，同时也是提升医保基金 治理水平的举措。 从1994年职工医保改革的"两江试点"（江西九江、江苏镇江）算起，长期以来，中国的医保是以县 级统筹为主，医保基金的资金池建立在县里，这导致各地在筹资水平、待遇标准、支付方式和预算管 理等各不相同，医保制度出现严重碎片化。 "十四五"期间，我国基本实现了医保基金的市级统筹，"十五五"努力推进省级统筹。 从地方实施的省级统筹模式看，主要是两种：一是统收统支的模式，即全省（市）医保基金统一征 收、管理和支出，北京、上海、天津、重庆、海南等省（市）实现了统收统支，这些省份的特点是内 部差异较小，其中4个是直辖市。此外，还有青海在居民医保实现省级统收统支的基础上，将在2026 年1月1日实施职工医保省级统筹，设置3年过渡期，过渡期后适时实行基金省级统收统支。 另一种是更加主流的省级调剂金模式，通常设立基础调剂金和紧急调剂金。基础调剂金用于事前均衡 各地因老龄化、人口结构等因素造成的基金压力；紧急调剂金用于事后弥补基金当期缺口，应对重大 疫情等突发风 ...

第一财经采访的专家表示，医保省级统筹是让绝大多数参保人受益的改革，它赋予了参保人更大的就医 自主权、更公平的待遇保障、更便捷的经办服务，但对于医疗机构来说则是机遇和挑战并存，三级医院 的"虹吸效应"可能会加剧，这对医疗机构自身能力的提升以及医保基金的监管提出了更高要求。 医疗市场结构将进一步分化。 国务院常务会议日前对推进省级统筹作出了进一步的部署。目前，全国已有20个省份发文推进省级统 筹。 2026年，医保省级统筹加速之年 "推进基本医疗保险省级统筹"已明确写入"十五五"规划建议之中。2026年，我国将在全面做实市地级统 筹的基础上，稳步推进基本医保省级统筹。 2026年医保省级统筹提速，将对普通人的求医问药带来哪些影响？ 基本医保省级统筹可以扩大医保基金共济范围、提高医保基金抵御风险能力，同时也是提升医保基金治 理水平的举措。 医疗战略咨询公司Latitude Health创始人赵衡表示，省级调剂基金一般是地级市当地筹资额的1%～5%， 对当地的医保基金平稳发展的影响有限，却能弥补省内筹资能力较差地区不足，也能降低中央和省级财 政原先对这些地区补贴的压力。 全国医保工作会议要求，明年稳妥推进基本医保省级 ...

转自：贵州日报 "近年来，全省已全面推行医保窗口'一窗通办。'"省医保局相关负责人介绍，下一步，将依托技术赋能 与流程再造，持续做好医保便民利民服务，推动医保公共服务均衡有序发展。 （贵阳日报融媒体记者 曾秦） （《个人账户资金转移可"即时到账"》由贵阳日报为您提供，转载请注明来源，未经书面授权许可，不 得转载或镜像。） 优化省内医保关系转移接续。新模式将打破以往需出具联系函在多个参保地流转办理医保关系转移接续 的模式，推行省内参保关系年限免转移，即在省内转移基本医疗保险关系时，参保人员的缴费年限无需 手动办理转移手续，系统会自动累计，以简化流程。同时，个人账户资金转移效率大幅提升：线下申请 方面，将个人账户转移时间从国家医保局统一规定的15个工作日压缩为"即时到账"；线上申请"T+1"个 工作日到账，即医保经办部门在结算数据生成后的1个工作日内完成费用拨付，真正做到"数据多跑路、 群众少跑腿"。 拓展门诊慢特病"一院通办"服务范围。目前，参保患者可通过线上线下方式办理门诊慢特病业务。线上 方面，参保人点击"贵州医保"APP或微信公众号，可直接变更异地定点医疗机构等内容；线下方面，可 到指定医院直接办理高血压 ...

今年的全国医疗保障工作会议提出，深入推进医保改革，积极推进科技创新，助力医疗事业和医药产业 发展，持续为人民健康、经济社会发展和科技进步注入医保新动能，努力实现"十五五"时期医保事业良 好开局。 从异地就医刷卡直接结算、医保钱包跨省共济，到创新药更快进医保、更多质优价宜的集采药品进基 层，再到生育保险让生娃少花钱、长期护理保险试点覆盖3亿人，"十四五"期间，医保改革的制度红利 持续释放，为我国的民生保障与医药产业升级注入确定性。 当前，我国医保制度面临的最大挑战是在人口老龄化趋势下医保基金收支平衡的压力，尤其是一些老年 抚养比高的地区抵御风险能力较为脆弱，急需通过提高统筹层次来发挥保险互助共济优势。同时，科技 和社会进步也为医保制度带来了一系列新挑战，以传统单位劳动关系为基础的职工医保需要适应新就业 形态的变化。 "十四五"期间，医保制度的另一个新变化是全民参保结构逐步优化，职工医保人数占总参保人数比重逐 年增加。今年的中央经济工作会议提出，鼓励支持灵活就业人员、新就业形态人员参加职工保险，将更 多的劳动者纳入职工医保这一更加稳健的社保体系也是全民医保下一步的方向。 截至2024年底，全国基本医疗保险（下称" ...

国家医保局数据显示，5年来，医保基金运行总体平稳，基金收支平衡，基本医保参保率稳定在95%，基金总支出超过13万亿 元；医保制度不断完善，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。 截至2024年底，全国基本医疗保险（下称"基本医保"）参保132662.08万人，2024年基本医保（含生育保险）基金总收入 34913.37亿元，基金总支出29764.03亿元；统筹基金当期结存4639.17亿元，累计结存38628.52亿元。 从年度基金结余数据可知，我国医疗保障资金基本盘稳健，2023年~2024年，国家医保局公布的累计结余数据为统筹基金累计结 余，不含职工基本医保个人账户，分别为3.4万亿元、3.9万亿元。若加上个人账户资金结余，总的累计结余为4.3万亿、4.8万 亿，五年来保持稳定增长。 医保省级统筹涉及关键的利益调整。 从异地就医刷卡直接结算、医保钱包跨省共济，到创新药更快进医保、更多质优价宜的集采药品进基层，再到生育保险让生娃 少花钱、长期护理保险试点覆盖3亿人，"十四五"期间，医保改革的制度红利持续释放，为我国的民生保障与医药产业升级注入 确定性。 当前，我国医保制度 ...

Core Viewpoint - The article discusses the key focus areas for the national medical insurance system in China for 2026, emphasizing the goal of making childbirth essentially free nationwide and enhancing the overall management and efficiency of medical insurance funds [1][4]. Group 1: Key Focus Areas for 2026 - The national medical insurance system will focus on consolidating universal coverage and improving the basic medical insurance system [1]. - There will be support for the development of commercial health insurance to establish a multi-tiered medical security system [1]. - Strengthening the management of medical insurance funds to ensure their safety is a priority [1]. Group 2: Childbirth Cost Reduction - The initiative aims for childbirth to be essentially free across the country by 2026, with specific measures to include flexible employment workers and migrant workers in maternity insurance coverage [4]. - Seven provinces, including Jilin, Jiangsu, and Shandong, have already achieved the goal of making childbirth free [4]. - The plan includes enhancing prenatal care coverage and ensuring direct payment of maternity benefits to insured individuals [4]. Group 3: Long-term Care Insurance Development - The long-term care insurance system currently covers approximately 300 million insured individuals and has benefited over 3.3 million disabled individuals [5]. - The focus will be on optimizing long-term care services and encouraging commercial insurance institutions to develop related products [5]. Group 4: Fund Management and Efficiency - The article highlights the importance of the proper use of medical insurance funds, which are crucial for public health [8]. - Measures have been taken to combat fraud, with approximately 120 billion yuan recovered over five years [8]. - The implementation of a new payment system and the promotion of real-time settlement of medical insurance funds are planned for 2026 [10]. Group 5: Drug Procurement and Innovation - The national centralized drug procurement has become a regular practice, with the latest round including 55 drugs aimed at stabilizing clinical use and ensuring quality [12]. - The introduction of a commercial insurance drug directory aims to cover innovative drugs that exceed basic insurance coverage [13]. - The focus on digitalization and artificial intelligence in medical insurance governance is expected to enhance policy implementation and industry vitality [14][15].

Investment Rating - The investment rating for the industry is "Positive" and the rating has been maintained [2] Core Views - The pharmaceutical and biotechnology industry index experienced a decline of 4.40%, ranking 23rd among 31 primary industries, underperforming the CSI 300 index which fell by 2.19% [6][18] - The valuation of the pharmaceutical and biotechnology industry as of November 28, 2025, is a PE (TTM overall method, excluding negative values) of 29.46x, down from 30.89x in the previous period, indicating a downward trend and below the average [22] - The report highlights potential beneficiaries from the upcoming ASH data, particularly in blood diseases and companies with solid grassroots channels, as well as those with differentiated advantages in oncology, autoimmune, and rare disease products [10] Summary by Sections Industry Review - The pharmaceutical and biotechnology industry index fell by 4.40%, with chemical preparations and medical devices showing declines of 2.86% and 2.95% respectively, while offline pharmacies and vaccines saw larger declines of 8.22% and 6.42% [6][18] - The PE ratio for the pharmaceutical and biotechnology industry is 29.46x, with the highest valuations in the vaccine (47.56x), hospital (41.17x), and medical device (36.77x) sectors, while pharmaceutical circulation has the lowest at 14.58x [22] Important Industry News - The National Administration of Traditional Chinese Medicine and the National Healthcare Security Administration released a directory for traditional Chinese medicine diseases suitable for disease-based payment [26][27] - AstraZeneca's drug "Durvalumab" received FDA approval for a new indication in perioperative treatment of gastric cancer [32] - Otsuka Pharmaceutical's new drug for IgA nephropathy, "Sibeprenlimab," has been approved by the FDA [38] - Bayer's first-in-class lung cancer drug "Sevabertinib" has been approved by the FDA for specific patient populations [40] Investment Recommendations - Focus on innovative pharmaceutical companies that may benefit from the medical insurance or commercial insurance directories, blood cancer targets with imminent ASH data releases, and biotech and CXO leaders with solid technology platforms and international collaboration expectations [10]

Investment Rating - The report maintains a "Buy" rating for the medical services industry, suggesting a positive outlook for the sector in the next 6-12 months [9][63]. Core Insights - The medical services sector has shown resilience, with a recent performance boost attributed to the seasonal increase in flu cases, despite ongoing cost control pressures from medical insurance [9][63]. - The report highlights the significance of the recent government initiative to promote provincial-level medical insurance coordination, which is expected to enhance the efficiency of fund utilization and improve the overall healthcare system [5][6][61]. - The medical services sector's current Price-to-Earnings (PE) ratio is 31.62, with a Price-to-Book (PB) ratio of 3.18, indicating a slight increase from the previous week [4][29]. Summary by Sections Industry Performance - The pharmaceutical and biological sector experienced a decline of 2.67% this week, ranking 17th among 31 primary industries [2][11]. - The medical services sub-sector reported a slight increase of 1.42%, closing at 6237.83 points [22][23]. Company Performance - Top-performing companies in the medical services sector include ST Zhongzhu (+16.3%), Baihua Pharmaceutical (+11.6%), and Lanwei Medical (+10.6%) [3][27]. - Underperforming companies include Aier Eye Hospital (-1.6%) and WuXi AppTec (-0.7%) [3][27]. Valuation Metrics - The medical services sector's PE ratio has increased by 0.40 from the previous week, while the PB ratio has risen by 0.04 [4][29]. - The maximum and minimum PE ratios over the past year were 41.13 and 28.46, respectively, indicating a relatively stable valuation range [4][29]. Government Policy Impact - The recent government meeting emphasized the importance of provincial-level medical insurance coordination, which aims to balance fund distribution across regions and enhance the overall healthcare system [5][6][61]. - The report identifies structural opportunities for the pharmaceutical industry, particularly in innovative drugs, medical devices, and healthcare information technology, as a result of the new insurance policies [6][62]. Investment Recommendations - The report suggests focusing on high-growth areas such as pharmaceutical outsourcing services and companies with improving profit margins, including WuXi AppTec and Aier Eye Hospital [9][63].