医疗保险

Search documents
服务提质、监管增效……2025上半年德州医保工作亮点纷呈
Qi Lu Wan Bao Wang· 2025-07-24 08:24
Core Viewpoint - The medical insurance system in Dezhou has shown significant progress in the first half of 2025, with various initiatives enhancing the public's sense of security regarding medical insurance [3][4][12]. Group 1: Medical Insurance Fund Performance - In the first half of 2025, the total income of the city's medical insurance fund was 3.886 billion, while total expenditure reached 4.607 billion, resulting in a cumulative balance of 7.352 billion [4]. - The employee medical insurance fund generated an income of 2.349 billion, a year-on-year increase of 6.68%, with expenditures of 1.991 billion, up 3.54% [4]. - The resident medical insurance fund had an income of 1.537 billion and expenditures of 2.616 billion, with a budget execution rate of 54.81% [4]. Group 2: Healthcare Reform and Initiatives - The city has implemented a "Three Medical Linkage + Traditional Chinese Medicine" reform, resulting in savings of 755 million from drug and consumable procurement [5]. - The "Dezhou Huimin Bao" commercial insurance program has seen participation from 334,800 individuals by the end of June [5]. - The city has expanded the number of designated medical institutions for traditional Chinese medicine from 81 to 115 [5]. Group 3: Service Capability Enhancement - The medical insurance settlement process has been optimized, reducing the settlement cycle to 15 working days [6]. - The city aims to cover 5.074 million insured individuals by 2025, with an additional 49,500 new participants this year [6]. - The online processing of medical expense reimbursements reached 12.2045 million cases in the first half of the year [6]. Group 4: Fund Supervision and Management - The city recovered and returned 22.1135 million in medical insurance funds and imposed administrative penalties totaling 3.4545 million in the first half of the year [8]. - A credit and joint supervision system has been established to manage the qualifications of personnel in designated medical institutions [9]. Group 5: Ongoing Reforms and Innovations - The city has implemented reforms in major disease medical insurance and assistance systems, benefiting 110,100 individuals with a total expenditure of 43.0352 million [10]. - The average hospitalization cost has decreased by 6.57% compared to the previous year, with personal hospitalization burdens reduced by 6.84% [10]. - The city has introduced a unified major disease insurance fund, saving 85 million in resident fund expenditures [11]. Group 6: Future Directions - The medical insurance bureau plans to continue deepening reforms and ensuring comprehensive coverage for the population, aiming to enhance the quality of medical insurance services [12].
高质量完成“十四五”规划丨“十四五”医保基金支出12.13万亿元 我国医保事业提质扩面
Xin Hua She· 2025-07-24 07:21
Core Insights - The "14th Five-Year Plan" aims to enhance the national medical insurance system, achieving a stable coverage rate of approximately 95% and a cumulative expenditure of 12.13 trillion yuan, with an annual growth rate of 9.1% [1][3] Group 1: Medical Insurance Coverage - By 2024, nearly 200 million medical visits will benefit from insurance reimbursement, representing a 1.6 times increase compared to 2020 [3] - As of June 2025, 253 million people are expected to participate in maternity insurance, with cumulative expenditures reaching 438.3 billion yuan and benefits enjoyed by 96.14 million people [3] Group 2: Long-term Care and Elderly Support - A long-term care insurance system is being established, with 190 million participants expected by the end of 2024, addressing the needs of disabled individuals [3] - Over 95% of village clinics will be included in the insurance system, facilitating access to medical services for the elderly [3] Group 3: Medical Institutions and Cross-Province Services - By June 2025, the number of designated medical institutions for insurance will reach 1.1 million, expanding the coverage of employee insurance to include close relatives [4] - The number of cross-province designated medical institutions has reached 644,000, benefiting 560 million medical visits and reducing out-of-pocket expenses by 590 billion yuan [4] Group 4: Support for New Medical Technologies - A total of 402 new drugs have been added to the insurance catalog since the beginning of the "14th Five-Year Plan," with ongoing reforms in payment methods to promote new technologies and equipment in clinical applications [4] Group 5: Poverty Alleviation and Future Directions - Medical assistance policies have benefited 673 million rural low-income individuals, alleviating over 650 billion yuan in medical expenses [5] - The National Medical Insurance Administration aims to manage insurance funds effectively while supporting the development of the pharmaceutical industry and enhancing the availability of safe and efficient medical products and services [5]
“十四五”医保成绩单发布,医保基金累计支出超12万亿元
Di Yi Cai Jing· 2025-07-24 05:01
Group 1: Healthcare Insurance and Coverage - The national basic medical insurance coverage rate remains stable at around 95%, with an expected 1.327 billion people insured by 2024, representing a 1.6 times increase from 2020 [1][3] - Cumulative expenditure of the medical insurance fund during the 14th Five-Year Plan period reached 12.13 trillion yuan, with an annual growth rate of 9.1% [1] - The multi-tiered medical security system is being established, including basic medical insurance, serious illness insurance, and medical assistance [3] Group 2: Long-term Care Insurance - As of June 2025, 253 million people are expected to participate in maternity insurance, with cumulative expenditures of 438.3 billion yuan [3][4] - The long-term care insurance system aims to alleviate the financial burden of daily care for the elderly and disabled individuals [3][4] Group 3: Medical Fund Management and Regulation - The National Medical Insurance Administration is enhancing the regulation of medical insurance funds to combat fraud and misuse, with 335,000 medical institutions inspected in the first half of the year, recovering 16.13 billion yuan [7] - The transition from a "post-payment" to a "pre-payment" system is being implemented, promoting efficiency in medical institutions and reducing patient out-of-pocket expenses by approximately 5% year-on-year [6] Group 4: Drug Price Governance - The 11th batch of centralized drug procurement has been initiated, emphasizing principles such as maintaining clinical stability and ensuring quality [9] - Since 2018, 10 batches of drug procurement have been conducted at the national level, covering 435 types of drugs, which has helped lower drug costs and improve accessibility [9]
国家医保局答21:改革支付方式,患者个人负担同比下降5%
2 1 Shi Ji Jing Ji Bao Dao· 2025-07-24 04:03
21世纪经济报道记者 贺佳雯 北京报道 在推进科技赋能方面,全国统一的医保信息平台全面建成,医保业务编码标准全国统一,医保智能管理水平显著提升。医保码、移动支付和电子处方全面应 用,群众就医购药更加便捷。跨省异地就医直接结算人次从2020年的537万人次增加到2024年的2.38亿人次,增长了44倍,跨省异地就医住院费用直接结算 率超过了90%。 二是医保支付流程更加高效。近年来,医保基金支出持续稳定增长,不仅为广大参保群众的生命健康提供了坚实保障,也为医疗机构的发展提供了重要支 撑。 在推进协同发展方面,建立多层次医疗保障体系,医保各项改革持续赋能医疗机构和医药产业高质量发展。即时结算、直接结算、同步结算稳步推进。国家 医保药品目录实现了全国统一,目录内药品总数达到了3159种。医保支付方式不断完善。药品、医用耗材集中带量采购常态化制度化运行。医疗服务价格改 革试点有序推进,医疗服务价格动态调整机制全面建立。 南方财经·21世纪经济报道记者提问:深化医保支付方式改革是提高医疗资源使用效率的重要举措。国家医保局如何通过这些改革,引导医疗机构从"规模扩 张"转向"提质增效",更好地满足人民群众看病就医的需求? ...
四川就健全基本医疗保险参保长效机制公开征求意见 连续参保或将获得更高大病保险支付金额
Si Chuan Ri Bao· 2025-07-21 08:16
Group 1 - The annual cap for serious illness insurance for urban and rural residents in Sichuan Province is set uniformly at 300,000 yuan [1][2] - Starting from 2025, for residents who have participated in the medical insurance for four consecutive years, the maximum payment limit for serious illness insurance will increase by 4,000 yuan for each additional year of continuous participation [1][2] - For residents whose medical insurance fund reimbursement is zero in the current year, the maximum payment limit for serious illness insurance will also increase by 4,000 yuan in the following year [1][2] Group 2 - The incentives for continuous participation and zero reimbursement can be combined, with a total increase not exceeding 20% of the original cap for serious illness insurance [1][2] - For individuals who have interrupted their insurance, the maximum payment limit for serious illness insurance will be reduced by 4,000 yuan for each year of interruption, with a cumulative reduction not exceeding 20% of the original cap [2] - Individuals who re-enroll after a break will have their continuous participation years recalculated, but previously accumulated rewards for continuous participation will be retained [2] Group 3 - A waiting period for benefits will be established for individuals who have interrupted their insurance, with a fixed waiting period of three months for those who do not enroll during the concentrated enrollment period [3] - For each additional year of interruption, the variable waiting period will increase by one month, which can be reduced by paying additional premiums [3] - The total waiting period for those who have interrupted their insurance for four years or more will not be less than six months after restoration [3]
医保电子处方中心覆盖31个省份 医保便民服务和监管效能实现双提升
Yang Guang Wang· 2025-07-20 01:04
Group 1 - The National Medical Insurance Administration has revealed that the electronic prescription center now covers 31 provinces and regions, supporting interconnectivity and mutual recognition of electronic prescriptions across provinces [1] - As of the end of April this year, the electronic prescription center has connected 70,600 designated medical institutions and 271,400 designated retail pharmacies [1] - The implementation of the "Medical Insurance Drug Cloud Platform" aims to address issues such as difficulty in finding medications for insured individuals and designated medical institutions [1] Group 2 - The electronic prescription center has established a fully connected system that allows for traceability throughout the entire prescription process, effectively regulating the prescribing behavior of medical institutions [2] - The smart medical insurance system enhances both convenience for patients and regulatory efficiency, significantly reducing the potential for fraudulent activities [2] - The system integrates preemptive, ongoing, and post-event monitoring, allowing for immediate alerts to be sent to doctors' computers in case of any irregularities, thereby improving regulatory efficiency [2]
医药行业深度报告:2024年基本医保收支平稳,结构调整和扩覆盖继续推进
Guohai Securities· 2025-07-18 11:33
Investment Rating - The report does not explicitly state an investment rating for the pharmaceutical industry Core Insights - The report addresses key issues regarding the trends in medical insurance income and expenditure for 2024, the relationship between insurance income and macroeconomic factors, and the policy drivers behind data changes [2] - The basic medical insurance coverage rate is maintained at 95% by the end of 2024, with 1.32662 billion insured individuals, a decrease of 7.27 million from the previous year [4][5] - Basic medical insurance income for 2024 is projected at 3.4913 trillion yuan, a year-on-year increase of 4.2%, with employee insurance income at 2.3733 trillion yuan (up 3.5%) and resident insurance income at 1.1181 trillion yuan (up 5.8%) [21][36] - Basic medical insurance expenditure for 2024 is expected to reach 2.9764 trillion yuan, reflecting a year-on-year growth of 5.5% [36] - The report highlights significant disparities in the surplus rates of resident medical insurance across provinces, with 17 provinces showing positive rates and 14 negative [2] Summary by Sections 1. Medical Insurance Coverage - By the end of 2024, the basic medical insurance coverage rate is solidified at 95%, with 1.32662 billion insured individuals [4][5] - The structure of insured individuals shows an increase in employee insurance participants while resident insurance participants have decreased [7] 2. Income and Expenditure Trends - Basic medical insurance income for 2024 is projected at 3.4913 trillion yuan, with a 4.2% increase year-on-year [21] - Employee insurance income is expected to be 2.3733 trillion yuan, growing by 3.5%, while resident insurance income is anticipated to be 1.1181 trillion yuan, increasing by 5.8% [21] - Basic medical insurance expenditure is projected at 2.9764 trillion yuan, with a year-on-year growth of 5.5% [36] 3. Provincial Analysis - The report notes significant differences in the surplus rates of resident medical insurance across 31 provincial-level units, with 17 showing positive rates and 14 negative [2] 4. Fund Operation Overview - From January to May 2025, the medical insurance fund's operation is reported to be stable, with income of 1.2295 trillion yuan (up 5.9%) and expenditure of 944.3 billion yuan (up 1.2%) [69]
退休参保人员首超1亿,快速老龄化下医保面临这些挑战|晋观医养
Di Yi Cai Jing· 2025-07-17 12:17
Core Insights - The aging population and increased life expectancy are putting significant pressure on pension and medical insurance systems, necessitating reforms during the 14th Five-Year Plan period [1][8] - By 2024, the number of insured retirees in China's employee medical insurance will exceed 100 million, marking a new phase in the impact of aging on the medical insurance system [1][2] Group 1: Medical Insurance Statistics - As of the end of 2024, the total number of participants in basic medical insurance reached 1.32662 billion, maintaining a coverage rate of 95% [1] - The total revenue of basic medical insurance (including maternity insurance) for 2024 was 3.491337 trillion yuan, while total expenditures were 2.976403 trillion yuan, resulting in a current balance of 463.917 billion yuan [1] - The number of participants in employee medical insurance increased by 8.537 million to 379.4834 million, reflecting a growth rate of 2.3% [3][4] Group 2: Challenges and Trends - The growth rate of insured retirees has surpassed that of employed workers since 2021, indicating a shift in demographic dynamics [3][4] - The ratio of employed to retired participants in employee medical insurance has been declining, from 3 in 2012 to an estimated 2.63 in 2024 [3][4] - The total medical expenses for employee medical insurance participants reached 2.058746 trillion yuan in 2024, with a year-on-year increase of 3.6% [4] Group 3: Resident Medical Insurance - The number of participants in resident medical insurance has been declining for three consecutive years, dropping from a peak of 1.02 billion in 2019 to 950 million in 2024 [6][7] - In 2024, the revenue for resident medical insurance was 1.118091 trillion yuan, with expenditures of 1.066149 trillion yuan, resulting in a current balance of 51.942 billion yuan [7] Group 4: Long-term Care Insurance - A nationwide long-term care insurance system is expected to be introduced within the year, with 18.78634 million participants in pilot cities as of 2024 [10] - The long-term care insurance fund had a revenue of 24.415 billion yuan and expenditures of 13.108 billion yuan in 2024 [10] Group 5: Policy Recommendations - To address the challenges posed by an aging population, reforms in pension and medical insurance systems are essential, including the introduction of long-term care insurance [8][9] - The medical insurance system must enhance its capacity to meet the structural demands of elderly care, focusing on both the quantity and quality of medical services [9]
职工医保基金支出近2万亿,全国医保最新“年报”透露哪些信息
Xin Jing Bao· 2025-07-16 10:47
Core Insights - The National Healthcare Security Administration (NHSA) released the "2024 National Medical Security Development Statistical Bulletin," highlighting key figures related to health insurance enrollment and fund operations [1][2]. Group 1: Health Insurance Enrollment and Fund Operations - As of the end of 2024, the total number of basic medical insurance participants reached 1.32662 billion, maintaining a coverage rate of 95% [2]. - The total revenue for the basic medical insurance fund (including maternity insurance) in 2024 was CNY 34,913.37 billion, while total expenditures reached CNY 29,764.03 billion, resulting in a cumulative fund balance of CNY 38,628.52 billion [2]. - The employee medical insurance fund (including maternity insurance) reported a revenue of CNY 23,732.47 billion in 2024, a 3.5% increase from the previous year, with expenditures of CNY 19,102.54 billion, marking a 7.6% increase [2]. Group 2: Medical Treatment and Benefits - In 2024, the number of treatment beneficiaries under employee medical insurance was 5.308 billion, reflecting a 9.9% increase year-on-year [3]. - The total medical expenses for employee medical insurance participants reached CNY 20,587.46 billion, which is a 3.6% increase compared to the previous year [3]. Group 3: Long-term Care and Cross-Region Medical Services - By 2024, 49 pilot cities had a total of 18,786.34 million participants in long-term care insurance, with the number of beneficiaries rising from 835,000 in 2020 to 1,462,500 in 2024 [5]. - The number of cross-region medical service visits reached 397 million in 2024, with associated costs amounting to CNY 7,867.74 billion [5]. Group 4: Drug Procurement and Insurance Directory Adjustments - The NHSA has conducted ten rounds of national drug procurement, covering 435 types of drugs, with the eleventh round focusing on established drugs with strict quality requirements [6][7]. - Since its establishment in 2018, the NHSA has dynamically adjusted the medical insurance drug directory for seven consecutive years, adding a total of 835 drugs, with 91 new drugs included in 2024 [8][9].
镇江实现基本医保参保人员长护险全覆盖
Xin Hua Ri Bao· 2025-07-15 21:46
Core Viewpoint - The inclusion of urban and rural residents' basic medical insurance participants into the long-term care insurance (LTCI) system in Zhenjiang is a significant step in addressing the challenges of an aging population and improving the medical insurance system [1][2]. Group 1: Long-term Care Insurance Implementation - Starting from July 1, urban and rural residents' basic medical insurance participants are officially included in the LTCI coverage, providing essential support for disabled individuals [1]. - Since the implementation of the LTCI system on October 1, 2023, 3,463 severely disabled individuals have benefited from LTCI-related services, reducing the financial burden on families by over 35 million yuan [1][2]. - The LTCI fund reimburses 50 yuan per day for individuals requiring 24-hour care in nursing facilities, which can offset 1,500 yuan in care costs per month [2]. Group 2: Care Services and Support - The LTCI program offers diverse support options for families of severely disabled individuals, including institutional care, family care subsidies, home care services, and specialized care services [2]. - The family care subsidy is set at 10 yuan per person per day, providing financial support to family members who care for their loved ones [2]. Group 3: Policy Implementation and Optimization - To ensure smooth implementation of the new policy, the Zhenjiang Medical Insurance Bureau has optimized the application process, allowing online applications through the "Zhenjiang Long-term Care" app or in-person at designated service points [3]. - The bureau will continuously monitor the policy's effectiveness and make adjustments as necessary to enhance service quality and ensure that severely disabled individuals receive safe and standardized care [3].