2025年是很不平凡的一年，我国医疗保障体系在服务人口高质量发展和中国式现代化中向新向优发展，展现强大的制度韧性和民生温度。站在岁末回望， 这一年涌现的众多热词，如一个个生动的切片，记录下医保改革的进程、治理水平提升的风向，共同"拼"绘出一幅以人民健康为中心的奋斗图景。以 下，"中国医疗保险"为您解读2025年医疗保障领域的十大热词。 热词1："1+3+N" 国家医保局一直强调要健全"1+3+N"多层次医疗保障体系。具体来说，"1"是构建以全国统一的医保信息平台、医保大数据为核心的医保基础设施及服务 能力；"3"是完善基本医疗保险、大病保险、医疗救助三重梯次减负的基本医疗保障制度体系；"N"是引导支持商业健康保险、慈善捐赠、医疗互助、工会 职工互助等其他保障力量发挥作用。 近年来，国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重基本医疗保障制度进一步巩固提升。职工医保、居 民医保政策范围内住院费用报销比例分别达到80%和70%左右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。 大病保险进一步减负，城乡居民大病保险保障水平在基本医保基础上 ...

来源：中国医疗保险 2025年是很不平凡的一年，我国医疗保障体系在服务人口高质量发展和中国式现代化中向新向优发展， 展现强大的制度韧性和民生温度。站在岁末回望，这一年涌现的众多热词，如一个个生动的切片，记录 下医保改革的进程、治理水平提升的风向，共同"拼"绘出一幅以人民健康为中心的奋斗图景。以 下，"中国医疗保险"为您解读2025年医疗保障领域的十大热词。 热词1："1+3+N" 国家医保局一直强调要健全"1+3+N"多层次医疗保障体系。具体来说，"1"是构建以全国统一的医保信 息平台、医保大数据为核心的医保基础设施及服务能力；"3"是完善基本医疗保险、大病保险、医疗救 助三重梯次减负的基本医疗保障制度体系；"N"是引导支持商业健康保险、慈善捐赠、医疗互助、工会 职工互助等其他保障力量发挥作用。 近年来，国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重 基本医疗保障制度进一步巩固提升。职工医保、居民医保政策范围内住院费用报销比例分别达到80%和 70%左右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。大 病保险进一步减负，城乡居民大病保 ...

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].