长护险制度全国统一推行

Search documents
医保五年累计支出12万亿,长护险全国推广预期增强
第一财经· 2025-07-25 02:48
Core Viewpoint - The article discusses the achievements and future plans of China's medical insurance system during the "14th Five-Year Plan" period, highlighting improvements in coverage, fund management, and the introduction of long-term care insurance [1][3]. Group 1: Medical Insurance Coverage - The national basic medical insurance coverage rate remains stable at around 95%, with a cumulative expenditure of 12.13 trillion yuan, averaging an annual growth rate of 9.1% [1][3]. - By 2024, the number of people covered by basic medical insurance is expected to reach 1.327 billion, with long-term care insurance coverage at 190 million [1][3]. - The direct settlement rate for cross-provincial medical expenses exceeds 90%, and the national medical insurance drug list has been unified, totaling 3,159 types of drugs [1][3]. Group 2: Long-Term Care Insurance - The long-term care insurance system is expected to be implemented nationwide soon, as the current pilot programs have shown positive results [4][7]. - As of June 2025, 253 million people are participating in maternity insurance, with cumulative expenditures of 438.3 billion yuan, benefiting 96.14 million people [6]. - The long-term care insurance aims to alleviate the financial burden of daily care for elderly individuals who have lost their ability to care for themselves, addressing the increasing demand for elderly care services [6][7]. Group 3: Fund Management and Regulation - The medical insurance fund is under increasing pressure, and the focus will be on ensuring fund safety and risk assessment during the "15th Five-Year Plan" period [4][8]. - The reform of payment methods has transitioned from a "post-payment" to a "pre-payment" system, promoting efficiency in medical institutions and reducing patient out-of-pocket expenses by approximately 5% year-on-year [9][10]. - The National Medical Insurance Administration has intensified efforts to combat fraud and misuse of medical insurance funds, recovering 16.13 billion yuan in the first half of the year through inspections of 335,000 medical institutions [10][11]. Group 4: Drug Price Governance - The article emphasizes the importance of drug price governance, with the government supporting market-driven pricing while also maintaining oversight to prevent price manipulation [12][13]. - Since 2018, the government has conducted 10 rounds of centralized drug procurement, covering 435 types of drugs, which has helped lower drug prices and improve accessibility [13][14]. - The National Medical Insurance Administration is committed to ensuring fair pricing practices and encourages public reporting of unusually high drug prices [14].