Core Insights - Yantai's Medical Insurance Bureau has focused on the management of outpatient chronic special diseases, enhancing efficiency in medical insurance governance and fund utilization through standardized and intelligent approaches [1][5] Group 1: Financial Performance - Total expenses for outpatient chronic special diseases increased by 5.5% year-on-year, while total reimbursements rose by 3.9% [1] - Per capita expenses decreased by 2.4%, and average expenses per visit dropped by 8.3% [1] Group 2: Admission Management and Qualification Standards - The disease catalog for outpatient chronic special diseases and separately paid diseases consists of 82 types, with no new self-owned diseases to be recognized after 2025 [2] - The application process for qualification has been streamlined, allowing patients to apply for recognition at medical institutions and through the "Love Shandong" app, achieving a "zero-run" experience for patients [2] - A strict review process for qualification has been established, including regular expert audits and a mechanism for exiting patients who do not meet the cost threshold [2] Group 3: Information Technology and Cost Control - A drug cost control system for outpatient chronic special diseases has been implemented, linking drug usage directly to individual medical insurance settlements [3] - Regular analysis reports on outpatient chronic special disease expenses are compiled, and quarterly meetings are held to discuss cost control issues [3] - Training sessions are conducted for grassroots medical institutions to enhance awareness of cost control [3] Group 4: Quality Development of Medical Institutions - The first chronic disease health management center has been established in Yantai, integrating various services for chronic disease management [4] - A clinical expert team has been formed to develop treatment plans and ensure standardized management across hospitals [4] - Regulations for drug management have been established, promoting the use of domestic and collective procurement drugs while embedding management rules into prescription systems [4] Group 5: Future Outlook - Yantai will continue to optimize its management model for outpatient chronic special diseases, exploring innovative reforms in the medical insurance sector to enhance service quality and efficiency [5]