Core Viewpoint - The implementation of direct settlement between medical insurance and pharmaceutical companies has raised significant cash flow concerns for hospitals, as the new model alters the traditional payment cycle and may exacerbate existing financial pressures [1][3][5]. Group 1: Cash Flow Anxiety - Hospitals are experiencing heightened cash flow anxiety due to ongoing reforms in medical insurance payment methods and adjustments in medical service pricing, leading to reduced revenues and difficulties in payroll [2][5]. - The transition to direct settlement has caused hospitals to worry about the potential disruption of cash flow, which has historically been a crucial part of their financial stability [3][5]. - The average accounts receivable days for hospitals from pharmaceutical companies is reported to be 152 days, indicating a significant delay in cash inflow [6]. Group 2: Direct and Instant Settlement Policies - The direct settlement policy, which allows local medical insurance departments to settle payments with pharmaceutical companies directly, aims to shorten the payment cycle to within one month [1][3]. - The introduction of the prepayment system by the National Medical Insurance Administration in November 2024 is intended to alleviate cash flow pressures by allowing hospitals to apply for advance payments from the insurance fund [10][11]. - The prepayment system has been criticized for its stringent application requirements, making it difficult for hospitals to access these funds, which were previously more readily available under the old turnover fund system [11][12]. Group 3: Operational Adjustments in Hospitals - Hospitals are adjusting their procurement strategies due to cash flow constraints, often reducing inventory levels to avoid the risk of stockpiling unsold medications [8][10]. - The pressure to maintain timely payments to pharmaceutical companies has led some hospitals to consider taking loans to meet their obligations, which poses compliance risks [17]. - The implementation of daily or weekly settlement trials in some regions has been viewed positively by hospitals, as it provides more immediate cash flow without significantly increasing administrative burdens [25][24]. Group 4: Future Outlook - The goal of achieving instant settlement for medical insurance funds with designated medical institutions is set for 2025, with a target of 80% of regions implementing this by then [23]. - Concerns remain regarding the potential increase in operational workload for hospitals due to more frequent settlements, although initial feedback suggests that the benefits of improved cash flow outweigh these concerns [24][25].