"今年以来，飞行检查实现了所有统筹地区、各类医保基金使用主体全覆盖。"黄华波说，同时，我们深 入治理医保"回流药"历史顽疾，开展应用追溯码打击欺诈骗保和违法违规行为专项行动。 医保，一头连着社会民生，一头连着医药产业。 "'十四五'以来，医保基金累计支出12.13万亿元。"章轲说，12.13万亿元既为人民群众看病就医报销提 供资金保障，也为医药行业发展、医药技术进步、产业转型升级提供支持。 章轲表示，国家医保局将持续管好、用好医保基金，在守护全体人民生命健康的同时，也为包括医药产 业在内的各相关产业发展持续注入强劲动力，在更高水平上助力健康中国建设。 （上接1版） 全国统一的医保信息平台系统响应时间实现毫秒级、全国跨省联网定点医药机构达64.4万家、基本医保 关系转移接续、生育保险待遇核定与支付等8项高频事项实现"跨省通办"……聚焦群众医保领域急难愁 盼，大数据、人工智能等技术正让医保便民服务更加可触可及。 在赋能医保服务的同时，数据化、智能化也让欺诈骗保等违法违规行为更加无处遁形。 据介绍，我国医保基金监管体系已全面建立，已累计追回医保基金超1000亿元。 ...

新华社北京8月24日电 医保，关系着每个人的切身利益，是民生保障中的重要一环。 以解除全体人民的疾病医疗后顾之忧为根本目的，"十四五"以来，我国医保提质扩面广覆盖，进一步减 轻人民群众疾病医疗负担，守好"看病钱""救命钱"。 全民参保进入新阶段 国家医保局局长章轲介绍，"十四五"期间，全国基本医保参保率稳定在95%左右。2021年至2024年，累 计近200亿人次享受医保报销。 "居民医保是我送给孩子的第一份礼物！"山东济南刘女士产后住院时，便线上为孩子办好了医保。 新生儿凭出生证明就可以参保，参保后即可享受待遇；进一步放开放宽参保户籍限制；创新建立参保缴 费激励约束机制……我国全民参保进入新阶段。 ——扩大生育保险覆盖面。截至2025年6月，有2.53亿人参加生育保险，基金累计支出4383亿元，享受 待遇9614.32万人次。 "目前，全国有近六成统筹地区将生育津贴直接发放给参保女职工。"章轲说，我们将加快新生儿护理、 分娩镇痛等价格项目立项，促进儿科、产科优化服务，积极推动目录内生育医疗费用全报销。 ——完善大病保险、医疗救助制度。"十四五"时期各项医保帮扶政策累计惠及农村低收入人口就医达到 6.73亿人 ...

在长三角某三甲医院的诊室里，67岁的李阿姨请医生开甲状腺超声检查单，系统自动弹出提示："您近3 个月已在社区医院完成甲状腺功能检测，本次检查属于重复申请。"医生随即撤回检查，并建议优先参 考社区检查结果。这一幕的背后，是医保结算数据与医院诊疗数据的联通在发挥作用。 医保部门与医疗机构常被认为是"监管与被监管"的对立关系，在一些案例中，甚至会出现医保部门为防 骗保而过度依赖事后稽核，医疗机构为控成本增营收，可能出现分解住院、过度检查等不当医疗行为。 如今，医保与医疗体系正在从被动衔接转向主动协同。而这一转向的核心密码，就藏在海量数据的流动 与整合之中。医保数据与医疗机构数据，一个是"医疗保障账本"，一个是"健康诊疗日志"。当二者打破 壁垒、深度融合，便形成了双向治理的数字引擎，既为医保基金安全筑牢防线，又为医疗服务提质增效 注入动能。 在辽宁大连，住院均次费用、检查检验和药品占比、月度费用变化、同病种费用结构均值……数据共享 帮助医院告别"经验决策"模式，智能监控系统的预警功能为精细化管理提供了有力保障；在福建福州， 通过数据可视化应用体系，定点医疗机构不仅能快速获取自身的汇总分析数据，还能获取医保公开的各 类 ...

对医保部门而言，数据是精准监管的重要手段。通过打通医保结算数据、医院信息系统数据、药品耗材 追溯数据，医保部门能构建起全链条监管体系。比如，浙江省依托国家医保信息平台，将参保人历史就 诊记录、药品进销存数据与实时结算信息交叉比对，2024年上半年识别出"挂床住院""虚开检查"等疑点 线索1.2万条，挽回基金损失2.3亿元。 对医疗机构而言，如及时掌握医保支付数据、患者流向数据、药品使用数据，可以更科学地优化资源配 置。但在以往，数据的调用是单向的，也就是医保部门能够掌握医疗机构相关信息，但医保基金的运行 情况以及医保部门掌握的医疗机构之间数据比对，医疗机构无从获取，并不利于医疗机构提升服务效 率。 在长三角某三甲医院的诊室里，67岁的李阿姨请医生开甲状腺超声检查单，系统自动弹出提示："您近3 个月已在社区医院完成甲状腺功能检测，本次检查属于重复申请。"医生随即撤回检查，并建议优先参 考社区检查结果。这一幕的背后，是医保结算数据与医院诊疗数据的联通在发挥作用。 2024年7月，国家医保局印发《国家医疗保障局办公室关于印发按病组和病种分值付费2.0版分组方案并 深入推进相关工作的通知》，提出各地应建立医保数据工作 ...

黄雨昕 Yuxin Huang 周林泓 Amber Zhou yx.huang@htisec.com amber.lh.zhou@htisec.com [Table_Title] 研究报告 Research Report 15 Aug 2025 中国财富管理 China (Overseas) Wealth Management 伯克希尔二季度调仓：低位布局联合健康，加地产钢铁，减科技与银行 Berkshire's 2Q25 Portfolio Change: Bargain Entry into UNH, Add Real Estate & Steel, Cut Tech and Banks [Table_yemei1] 热点速评 Flash Analysis [Table_summary] (Please see APPENDIX 1 for English summary) 8 月 15 日，伯克希尔公布了 2Q25 持仓报告和 1Q25 未公开的保密持仓，二季度整体调仓幅度不大，持仓总市值小幅 减少至 2575 亿美元，前十大重仓股占比小幅回落至 87.3%。二季度在周期低谷期布局优质标的和行业的同时， ...

Group 1 - The National Medical Insurance Administration (NMIA) has intensified the regulation of medical insurance funds by holding individuals accountable for violations, marking a shift from solely punishing institutions to also targeting responsible personnel [1][2] - A case in Jiangxi Province highlighted this approach, where individuals involved in fraudulent activities were penalized with points against their medical insurance payment qualifications, indicating a more stringent accountability system [1] - The introduction of a point-based management system for medical insurance payment qualifications aims to enhance the precision and deterrent effect of regulatory measures, extending oversight to specific individuals within medical institutions [2][3] Group 2 - The regulatory framework emphasizes a balanced approach, combining education and punishment, with mechanisms in place to protect the rights of medical personnel while ensuring accountability [3] - Various provinces have implemented dynamic responsibility recognition mechanisms to ensure that accountability is accurately assigned, preventing generalized or superficial handling of violations [3] - The overarching goal is to ensure the proper and compliant use of medical insurance funds, which are critical for the health and well-being of over 1.3 billion insured individuals in the country [2][3]

Core Viewpoint - The National Healthcare Security Administration (NHSA) has emphasized the importance of deepening healthcare reform during the "14th Five-Year Plan" period, focusing on the integration of healthcare services with economic and social development [1][2]. Group 1: Healthcare Fund Management - The NHSA has managed a total healthcare fund expenditure of 12.13 trillion yuan, with an average annual growth rate of 9.1% since the beginning of the "14th Five-Year Plan" [2]. - The healthcare fund has significantly supported the pharmaceutical industry, with expenditures on innovative drugs projected to reach 3.9 times the 2020 level by 2024, reflecting an annual growth rate of 40% [2]. Group 2: Reforms and Innovations - The NHSA has implemented a prepayment system for healthcare funds and promoted real-time settlement reforms, covering 357 regions nationwide, with a total of 594.8 billion yuan disbursed since 2025 [1][2]. - The introduction of the "dual directory" reform, including a new commercial health insurance innovative drug directory, aims to support pharmaceutical innovation, with over 100 drugs currently under application [2][3]. Group 3: Integration with Commercial Insurance - The NHSA has facilitated the integration of healthcare insurance with commercial insurance, resulting in over 27 million claims in Shandong province alone benefiting from a "one-stop settlement" service in 2024, enhancing the competitiveness of related insurance products [1][2]. Group 4: Future Directions - The NHSA plans to continue managing healthcare funds effectively while injecting strong momentum into the pharmaceutical industry, aiming to provide more efficient, safe, and accessible medical products and services [3]. - The basic medical insurance coverage rate has remained stable at around 95%, with 1.327 billion people insured in 2024, and annual medical assistance benefiting approximately 8 million people [3].

Core Viewpoint - The 2024 National Medical Security Development Statistical Bulletin indicates a significant improvement in the financial health of the medical insurance system, with a notable increase in the residents' medical insurance surplus and a decrease in the growth rate of total medical insurance expenditures compared to 2023 [3][4][5]. Group 1: Financial Health of Medical Insurance - The residents' medical insurance surplus reached 51.942 billion RMB in 2024, an increase of over 40.736 billion RMB compared to the previous year [4][7]. - The total medical insurance fund expenditure growth rate decreased to 5.5% in 2024, down from 14.7% in 2023, indicating a slower spending pace [21][22]. - The total income of the medical insurance fund in 2024 was 349.1337 billion RMB, reflecting a growth of 4.2% compared to 2023 [13][14]. Group 2: Changes in Insurance Participation - The total number of insured individuals in 2024 was 1.327 billion, with a participation rate maintained at 95%, despite a slight decrease in absolute numbers [13]. - The number of participants in employee medical insurance increased by 8.537 million (2.3%), while the number of residents' medical insurance participants decreased by approximately 15.8 million (1.6%) [13]. Group 3: Hospitalization and Medical Costs - The hospitalization rate continued to rise in 2024, but the growth rate was lower than in 2023, with the hospitalization rate for employee insurance rising from 17.6% in 2022 to 21.86% in 2023 [16][18]. - The average hospitalization costs for employee and resident medical insurance decreased to 11,707 RMB and 7,408.08 RMB, respectively, in 2024 [29]. Group 4: Cross-Regional Medical Treatment - The total number of cross-regional medical treatments reached 397 million in 2024, a 63.2% increase from the previous year, with total expenses amounting to 786.774 billion RMB, up 10.6% [6][24]. - The proportion of cross-regional medical treatment expenses in total medical insurance expenditures increased from 2.67% in 2021 to 6.56% in 2024 [26][27]. Group 5: Regulatory Changes and Challenges - Stricter regulations on fraudulent medical insurance claims have been implemented, recovering 27.5 billion RMB in 2023, contributing to the improved financial stability of the medical insurance fund [11]. - Local medical insurance bureaus are now prohibited from drafting deficit budgets, which is expected to enhance the financial management of medical insurance funds [12].

Group 1: Core Insights - The article emphasizes the focus of China's decision-making on technology, consumption, employment, foreign trade, and platform economy since the April Politburo meeting, aiming for a multi-dimensional collaboration to strengthen economic recovery [1] - Key areas of investigation include high-end manufacturing technologies, consumer policies, employment stability for specific groups, foreign trade orders, and digital consumption regulation [1] Group 2: Domestic Economic and Industrial Policies - The Central Financial Committee's meeting on July 1 highlighted the importance of building a unified national market and regulating low-price competition among enterprises [2] - Measures to support the high-quality development of innovative drugs were announced by the National Healthcare Security Administration and the National Health Commission [2] - The National Energy Administration held a mid-term meeting on wind and solar energy resource surveys on July 2 [2] - The State Council issued a notice on July 9 to further enhance employment support policies [2] Group 3: Capital Market Policies - The implementation of the new information disclosure management measures for listed companies began on July 1, clarifying industry disclosure requirements [3] - The China Securities Regulatory Commission approved the first batch of 10 technology innovation bond ETFs to guide funds into the technology sector [3] - The People's Bank of China released a draft for public consultation regarding the rules for the cross-border payment system on July 4 [3] Group 4: Global Geopolitical and Economic Tracking - The U.S. Congress passed the "Big and Beautiful" Act on July 3, indicating significant legislative changes [4] - OPEC+ agreed to increase production by 548,000 barrels per day starting in August [4] - The U.S. unemployment rate decreased to 4.1% with 147,000 new jobs added in June, reflecting a slight improvement in the labor market [4]

Digital Human Resources - The Ministry of Human Resources and Social Security has initiated a pilot program for the management and service reform of professional technical talents, focusing on six areas over two years, including postdoctoral work and vocational qualifications [2] - The third National Skills Competition will be held in Zhengzhou, Henan Province from September 20 to 22, featuring over 3,500 participants and more than 106 competition items, with a significant focus on intelligent manufacturing and digital technology [2] Employment and Labor - Wang Xiaoping emphasized the importance of implementing a new urbanization strategy to promote the transfer of rural labor, proposing six key areas for enhancement, including industry collaboration and skills training [3] Healthcare and Medical Services - The State Council is researching measures to optimize the procurement of drugs and medical supplies, aiming for a more standardized and institutionalized approach to procurement [8] - The National Healthcare Security Administration has issued a guideline for the pricing of urology services, consolidating 421 technical specifications into 108 items [10] - The per capita financial subsidy for urban and rural residents' medical insurance will increase by 30 yuan, reaching 700 yuan per person per year [11] Digital Healthcare - The National Health Commission has revised the standards for the evaluation of tertiary hospitals, enhancing requirements for management and service quality [12] - A joint initiative by 14 ministries aims to address and correct irregularities in the medical procurement and service sectors by 2025 [12] Digital Economy - In May, China's high-tech industry sales revenue grew by 15% year-on-year, indicating a strong growth trend, with significant increases in sectors like industrial robotics [7] - The Ministry of Industry and Information Technology and the Ministry of Civil Affairs are launching pilot projects for intelligent elderly care service robots from 2025 to 2027, focusing on improving the quality of life for the elderly [9]