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。 新华社北京8月24日电 题：织密医疗保障网——我国基本医保制度不断完善 新华社记者彭韵佳、徐鹏航 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"。 跨省共济，只是医保待遇保障"扩容 ...

深圳市医保局相关负责同志表示，将全力推进智慧医保建设，持续深化"互联网+医保"服务，积极拓展 医保码全流程应用、"一码付"、刷脸就医等便民服务场景，支持打造更多标杆项目，让参保群众医保改 革获得感成色更足、幸福感更可持续、安全感更有保障。 "一码付"功能是在医保码身份认证和医保结算原有功能基础上，融合第三方支付渠道，进一步改善参保 群众就医体验的重要举措。参保群众扫描医疗机构提供的二维码，进入医保"一码付"页面，点击页面 上"立即开通"，即可使用该功能。开通此项服务后无需再携带现金或银行卡，只需通过手机展示医保码 或者在自助终端前刷脸，便可完成从挂号、就诊、医保结算和现金结算的全部就医流程，真正实现 了"无卡就医、无码支付"。 在保障医保基金安全与公众隐私安全方面，"一码付"依托国家医保统一信息平台和技术规范，采用"人 脸识别+实名+实人"安全核验技术，在确保个人信息安全的前提下，实现医保与自费快速结算，可以有 效防范冒名就医、盗刷套刷医保卡等违法违规行为，有力维护医保基金安全。 据了解，近年来深圳市医保局大力推进医保便民服务改革，以医保电子凭证（医保码）、医保电子处 方、电子票据，移动支付、信用支付"三电子 ...

新华财经北京8月9日电据"市说新语"9日消息，近日，市场监管总局（国家标准委）发布《医疗保障信 息平台便民服务相关技术规范》（GB/T 45938—2025）推荐性国家标准，将于2026年1月1日起实施。 该标准由国家医疗保障局组织研制，是医疗保障领域的首项国家标准，标志着我国医保标准化建设取得 里程碑式突破。 《医疗保障信息平台便民服务相关技术规范》在医疗保障信息平台工程实践的基础上研究制定，核心技 术要求已在全国大规模应用，科学性、实用性和普适性经过充分验证，适用于定点医药机构、合作金融 机构、第三方支付机构、政务服务部门和其他机构等合作应用机构。标准规定了医保码（医保电子凭 证）、医保移动支付、医保电子处方、个人医保信息授权查询等医疗保障信息平台便民服务的接入方 式、接入功能要求、性能要求和安全要求。 （文章来源：新华财经） 近年来，医保信息化发展有力促进了医疗保障信息平台便民服务的发展。在已接入医疗保障信息平台便 民服务的定点医药机构，群众可通过手机验证或刷脸登录医保账户，轻松办理挂号、就医、检查化验、 打印报告单、拿取药品、办理住院、电子处方流转及医保结算等全场景全流程就医购药业务。全时在 线、渠道 ...

Group 1 - The core viewpoint of the articles highlights the significant advancements in healthcare services through digitalization during the "14th Five-Year Plan" period, emphasizing the convenience and efficiency brought to the public [1][2][3] - As of June 2025, over 1.236 billion people in China are expected to have activated and be using the medical insurance code, facilitating direct settlement for medical services across various scenarios [1] - The introduction of the "drug price comparison" mini-program aims to help citizens find reasonably priced medications easily, enhancing consumer choice and transparency in drug pricing [2] Group 2 - The number of people utilizing cross-provincial medical insurance direct settlement has surged from 5.37 million in 2020 to 238 million in 2024, marking a 44-fold increase, with over 90% of hospitalization costs settled directly [2] - Digitalization in healthcare services is not only about efficiency but also about enhancing the warmth of service, as seen in the implementation of bilingual voice broadcasting in healthcare facilities in Pingxiang, Jiangxi, catering to the elderly [3] - The balance between efficiency and warmth in healthcare services is a key aspect of the digital transformation, aiming to ensure that every insured individual feels valued and recognized in the digital age [3]

Group 1 - The core objective is to establish Hangzhou as a national model city for smart medical insurance, focusing on a health-centered approach and creating a new governance paradigm driven by intelligence, comprehensive coverage, multi-dimensional collaboration, and security [1][2] - The blueprint for the smart medical insurance initiative includes a total of 1 overall goal, 3 phased implementations, and 6 major smart projects, aiming for the realization of multiple landmark achievements [1][2] - The implementation of six major projects, including "Smart Integration for Common Prosperity" and "Smart Service," is expected to yield quantifiable results such as the "Yibaoer" AI agent and various innovative applications [2] Group 2 - The initiative aims to enhance public health and welfare by transforming the smart medical insurance blueprint into practical applications, contributing to a smarter and more intelligent urban landscape in Hangzhou [3]

Core Viewpoint - The cross-provincial medical treatment direct settlement policy has significantly improved the reimbursement process for patients, reducing the financial burden and streamlining the healthcare experience [2][4][11]. Group 1: Policy Impact - As of the first quarter of 2025, the cross-provincial direct settlement system has benefited 70.75 million insured individuals, reducing out-of-pocket expenses by 46.992 billion yuan, marking increases of 37.97% and 11.44% respectively compared to the same period in 2024 [2][7]. - The number of cross-provincial designated medical institutions reached 651,600, an increase of 0.77 million or 1.19% from the end of 2024 [7][8]. - The direct settlement for inpatient services accounted for 3.6389 million cases, reducing personal payments by 36.537 billion yuan, with growth rates of 11.92% and 5.68% respectively [7][8]. Group 2: Technological Advancements - The establishment of a unified national medical insurance information platform has facilitated seamless cross-provincial medical treatment settlements, ending the previous fragmented system [3][8]. - Patients can now complete the reimbursement process using electronic medical insurance credentials or social security cards, significantly reducing the need for physical paperwork and in-person visits [8][9]. Group 3: Regional Innovations - Various provinces have implemented innovative service models, such as automatic registration and immediate settlement for cross-provincial medical treatment, enhancing accessibility for patients [9][10]. - In Yunnan, the "Medical Insurance Market Day" initiative has improved access to services in remote areas, leading to a more than 40% increase in cross-provincial outpatient settlements in the first quarter of 2025 [10]. Group 4: Future Implications - The reforms in cross-provincial medical treatment not only alleviate financial burdens but also promote the free movement of labor and resources across regions, supporting the construction of a unified national market [11].

Group 1 - Xiamen has prioritized the implementation of the central eight regulations, focusing on addressing grassroots and public issues through concentrated rectification efforts [1] - A total of 2,805 issues were identified, with 4,860 corrective measures formulated, demonstrating a systematic approach to problem-solving [1] - Key areas of focus include alleviating pressure on grassroots reception and addressing issues related to elderly care, campus meals, property management, and medical insurance [1] Group 2 - The healthcare sector is a significant focus, with the Xiamen Health Commission implementing seven specific measures to optimize medical services [2] - Initiatives include the "Thousand Doctors Down to the Community" program, improving access to quality medical resources for residents [2] - The introduction of a "credit medical" model has reduced average waiting times for patients by 35 minutes, enhancing the overall healthcare experience [2] Group 3 - The satisfaction rate for school meal services in Xiamen reached 94.5%, indicating positive feedback from the community [3] - Approximately 20 million yuan in overdue village collective asset rents has been recovered, showcasing effective financial management [3] - The launch of an online refund feature for outpatient prepayments has been well-received, improving convenience for the public [3]

据国家医保局消息，近日，湖南省医保部门宣布，全省15个统筹区提前1个月完成上年度医保基金清算 工作，共向3.1万家定点医药机构拨付清算资金92.2亿元。 ...

Core Insights - The National Healthcare Security Administration (NHSA) has publicly released the first batch of intelligent supervision rules and knowledge points for medical insurance funds, aiming to enhance the regulation of medical insurance funds through a proactive reminder system [1][2]. Group 1: Intelligent Supervision Implementation - The intelligent supervision system is designed to identify and alert medical personnel of any violations during the prescription process, addressing issues before they escalate [1]. - The NHSA allows all designated medical institutions to access and utilize the intelligent supervision system for free, enhancing the efficiency and accuracy of preemptive reminders [1]. Group 2: Knowledge Base and Rules - The first batch of intelligent supervision rules includes over 10,000 detailed knowledge points across five categories, such as gender-specific drug usage and pediatric-specific medical services [1]. - The NHSA will continuously track, evaluate, and improve the knowledge base to ensure its scientific validity and accuracy [1]. Group 3: Dynamic Updates and Integration - Provincial healthcare departments are required to dynamically update their intelligent supervision systems based on the latest knowledge points and codes [2]. - Designated medical institutions are encouraged to integrate the intelligent supervision knowledge base into their own information systems to eliminate non-compliant behaviors at an early stage [2].