转自：成都日报锦观 制度筑基 服务赋能 用医保温度书写"民生答卷" ——成都市医疗保障工作"十四五"发展综述 数说"十四五" ■全市基本医保参保人数约1885万人。 ■新增949种药品进入医保目录。 ■300余家定点医疗机构实现医保码就医全流程应用。 ■建成"市县镇村"四级经办体系，设立200余个医保工作站。 ■长期护理保险参保累计享受待遇21.56万人。 "十四五"期间，全市基本医保参保人数约1885万人，职工医保和城乡居民医保参保规模稳步扩大；全市1.76万家定点医药机构实现了追溯码上 传，医药机构追溯码采集接入率为100%；截至2025年11月，全市长期护理保险参保累计享受待遇21.56万人……翻阅过去五年成都医保的"民生 账单"，一份份翔实的数据折射出全市人民不断提升的医保获得感。 幸福的体现，不仅在一串串上涨的数字之间，更在一句句群众切身的话语之中——"老伴胃癌手术，报销了大半费用""带娃看病刷个医保码， 全程不用找卡片""4岁患病孙女儿有了长护险上门护理，全家有了盼头"…… 从政策体系到服务落地，"十四五"期间，成都医保的惠民温度藏在千万市民的切身感受里。作为事关群众健康福祉的重大民生工程，成都以 ...

二、推进居民长期护理保险提质扩面。进一步完善长期护理保险筹资机制、待遇保障和照护服务质量，更大范围落地职工长护险辅具护具租赁，扩大失能 人员待遇享受范围，提升整体服务质量，提高失能人员长护服务获得感。 三、动态调整医疗服务项目价格。建立医疗服务项目价格动态调整机制，落地国家医疗服务项目立项指南，规范整合医疗服务价格项目，重点提高治疗 类、手术类等技术劳务类项目价格，支持新技术临床应用。 四、持续加大药品耗材集中带量采购力度。执行国家、省际联采中选结果，强化中选企业供应保障及医疗机构采购执行监测，压实医疗机构主体责任。积 极动员更多医保定点医药机构参加集采药品进基层活动，提高群众购药的便捷度，促进集采改革成果惠及更多的群众。 五、持续推进医保基金监管工作。坚决贯彻落实国家医保局关于推动专项整治系列要求，严厉打击欺诈骗保行为，形成基金监管高压态势。加强日常智能 监管和专项检查，及时落实举报投诉事项；依托基金监管联席会议制度，加强部门协同，形成监管合力。 六、上线医保AI智能语音客服。升级智能语音系统，引入大语言模型和方言识别功能，构建动态知识库，推行"全天候"智能咨询指引，打造全流程闭环服 务体系，实现语音客服" ...

"我也是一个有'医靠'的人了，以后更要在义乌安心创业了。"12月17日，来自俄罗斯的索菲亚 （002572）以灵活就业人员身份在浙江义乌市领到社保卡后高兴地说。索菲亚成为义乌第1万名参加基 本医保的外籍人员。义乌也成为全国首个外籍人员参保突破万人的县级市。 义乌素有"世界小商品之都"的称号，与全球233个国家和地区都有贸易往来。在义乌，每天活跃着约3万 名外商和1500多名随行家属。此前，外籍人员参加基本医疗保险仅限于企业就业参保，灵活就业的外籍 人员和众多随行家属都缺乏参保通道。 "为破解这个难题，义乌医保部门以深化义乌国际贸易综合改革为契机，获国家医保局批准，探索持有2 年及以上居留许可的外籍人员可按灵活就业人员身份参保，享受与中国公民同等报销待遇，填补了我国 外籍灵活就业人员的参保制度空白。"义乌市医保局局长楼俊说。 今年8月，在义乌经商的韩国人帕克成为全国首位外籍灵活就业人员医保参保人。"我今年50多岁，医保 这个重要问题解决了，让我在义乌的生活更安心。"帕克说。 细微之处见真章。11月初，在义乌工作的摩洛哥人吉米到浙江大学附属第四医院做胆囊切除手术。出院 结算时，1万多元的医药费，大部分已由医保统筹 ...

每经AI快讯，据国家医保局消息，12月13日，全国医疗保障工作会议在北京召开。会议指出，"十四 五"时期，推进医保数智赋能，有效提升医保管理服务水平。统一28项高频医保经办事项，9成实现线上 办理。5年来跨省异地就医直接结算超6亿人次，减少群众垫付6600亿元。建成全国统一的医保信息平 台，日均结算量2800万人次，累计12.5亿人激活医保码并实现刷码就医购药。建设医保影像云，20个省 份上传数据近2亿条。 ...

Core Insights - Guangzhou's healthcare system is enhancing transparency and efficiency through the implementation of a drug traceability code system, which allows citizens to track the source and flow of medications, thereby ensuring clarity in the use of medical insurance funds [1][2] Group 1: Drug Traceability System - The drug traceability code serves as an "electronic ID" for medications and is a crucial component of Guangzhou's healthcare information system, reflecting the city's commitment to improving public welfare through digital reforms [1][2] - As of early December, over 1.2 billion traceability codes have been uploaded, with a daily average of 5 million uploads, showcasing the effectiveness of the system in managing healthcare services [2] Group 2: Systematic Approach to Healthcare Reform - Guangzhou's healthcare reform follows a "step-by-step" approach, starting with retail pharmacies and gradually expanding to more complex medical institutions, ensuring a smooth transition and high-quality implementation [2] - The traceability data is not just numbers; it represents tangible improvements in healthcare services, providing a digital and transparent flow of medication from production to sale [2] Group 3: Data-Driven Healthcare Management - The integration of traceability data with the healthcare settlement system marks a shift from manual verification to a data-driven approach, significantly enhancing service efficiency and accuracy [3][5] - The "data-driven" model allows for real-time verification of traceability codes during medication purchases, streamlining the process for insured individuals [3] Group 4: Collaborative Governance and Public Engagement - Guangzhou's healthcare system promotes a collaborative governance model, involving multiple departments and the public in ensuring the safety of healthcare funds through the traceability system [6] - The system allows citizens to easily access information about their medications, empowering them to act as supervisors of healthcare fund usage [6] Group 5: Future Directions - Guangzhou plans to deepen the integration of drug traceability with healthcare fund supervision and enhance the use of artificial intelligence for risk assessment and trend analysis [6] - The focus remains on improving public health and ensuring the safety of healthcare funds while enhancing the overall experience for citizens in accessing medical services [6]

完成认证授权后，办理将进入参保登记填写流程，人员基础信息电子凭证授权系统自动获取。参保 登记信息点击"单位名称"右办理流程侧下拉按钮选择参保单位名称（精确到街道居委会），系统自动识 别单位编号。参保人员信息电子凭证授权自动获取出生日期、性别。参保人员可按照提示填写相关信 息。参保人员确认信息无误后，点击"生成参保登记表"按钮，按提示进行电子签名；点击上传材料，户 口簿、居住证或有效身份证件（任选一项）后，点击保存按钮完成参保登记。缴费参保登记完成后，参 保人员可通过支付宝或微信完成年度缴费。 需要注意的是，上传材料需清晰完整且保证真实有效。如果是新生儿或者其他无法正常扫码人员， 可以请亲属使用"河南医保"小程序帮办代办功能进行代办操作。 "城市码"参保登记具体流程该如何操作？首先，有需要的城乡居民，可以根据自身使用习惯，选择 支付宝或微信扫码识别"城市码"。 记者昨日从省医疗保障局获悉，河南省"城市码"服务正式上线，未办理过城乡居民医保参保登记的 居民，只需掏出手机轻松一扫，足不出户就能完成参保登记。 据介绍，全省18个地市分别有对应的"城市码"，居民可通过河南省医疗保障局官方微信查询选择所 需地市的"城市码 ...

Core Viewpoint - The National Healthcare Security Administration announced that over 90% of the coordinated areas have implemented direct payment of maternity benefits to individuals, with 27 provinces achieving this by December 1, leaving only 5 provinces yet to fully implement it [1]. Group 1: Implementation Status - As of December 1, 2023, 27 provinces, including the Xinjiang Production and Construction Corps, have fully implemented direct payment of maternity benefits to individuals [1]. - Only 5 provinces remain that have not fully implemented this system: Beijing, Tianjin, Guangxi, Guizhou, and Xinjiang [1]. Group 2: Statistical Overview - The coordinated areas where maternity benefits are directly paid to individuals account for over 90% of the total [1]. - The specific distribution of maternity benefit payments varies by province, with some areas still processing payments through units rather than directly to individuals [2].

Core Insights - The National Medical Insurance Administration reported that as of November 12, 2025, 24 provinces and the Xinjiang Production and Construction Corps have completed the deployment of medical insurance imaging cloud software, enabling data upload and cross-province access capabilities [1] Summary by Categories Deployment and Capabilities - 24 provinces and the Xinjiang Production and Construction Corps have completed the deployment of medical insurance imaging cloud software [1] - The system now supports the uploading of imaging cloud index data and cross-province retrieval of imaging data at the provincial platform level [1] Data Statistics - The total number of medical insurance imaging cloud index data uploaded has reached 140 million entries [1] - Provinces with over 10 million uploads include: - Henan: 24.776 million entries - Guangdong: 24.531 million entries - Jiangsu: 12.947 million entries - Shandong: 12.359 million entries - Gansu: 12.184 million entries - Shanghai: 10.412 million entries - Anhui: 10.111 million entries [1] - Provinces with over 1 million uploads include: - Fujian: 7.103 million entries - Jiangxi: 7.101 million entries - Sichuan: 5.976 million entries - Hubei: 3.291 million entries - Shaanxi: 2.795 million entries - Shanxi: 1.950 million entries - Hebei: 1.585 million entries - Xinjiang: 1.331 million entries [1] - Provinces with over 100,000 uploads include: - Guizhou: 754,000 entries - Inner Mongolia: 623,000 entries - Yunnan: 615,000 entries - Ningxia: 537,000 entries [1]

Core Points - The article discusses the optimization of maternity allowance disbursement in the province, effective from November 1, 2023, with direct payments to the insured individuals' accounts [1] - The new process aims to streamline the application and payment system for maternity benefits, reducing administrative burdens and enhancing efficiency [1] Summary by Sections Maternity Allowance Disbursement - Maternity allowance will be directly deposited into the accounts of eligible insured employees starting November 1, 2023 [1] - Employees who meet the "exemption from application" criteria or apply for maternity allowance with necessary documentation will receive payments after approval from the medical insurance agency [1] - Payments will be made within 10 working days from the date of application acceptance [1] Payment Methods - Local medical insurance agencies can choose between one-time or monthly payment methods, encouraging balanced payments during the employee's leave [1] - For employees who give birth in hospitals before November 1, 2025, maternity allowances will continue to be disbursed through the original channels [1] Process Optimization - The province's medical insurance system is implementing a closed-loop management model focusing on data sharing, which includes automatic verification, intelligent reminders, convenient processing, feedback, and risk prevention [1] - The system will utilize key information from designated medical institutions and the provincial business data sharing platform to match eligibility for claims, reducing manual errors and submission burdens [1] - Employees will receive application reminders through multiple channels, and they only need to confirm their account information via the national medical insurance service platform or local channels to initiate the automatic review and payment process [1]

Core Points - The introduction of a drug traceability code query function in the Shaanxi Medical Insurance App enhances drug safety by allowing insured individuals to scan codes for complete sales information [1][2] - The traceability code acts as a unique "electronic ID" for drugs, enabling users to verify the legitimacy of their purchases [1] - The system aims to address regulatory challenges in the pharmaceutical industry, such as monitoring designated institutions and preventing illegal sales [2] Group 1 - The new feature allows users to scan drug packaging to obtain sales information, categorized into three scenarios: no information found, single sale information, and multiple sale information [1] - If no sales information is found, users are advised to wait two days before retrying, indicating potential issues with the selling institution [1] - If multiple sales are detected, it raises concerns about the drug being potentially counterfeit or previously sold, prompting users to report and seek compensation [1] Group 2 - The province has established a drug traceability management system that includes a foundational database, drug management database, and verification rules database [2] - This system effectively addresses regulatory issues such as monitoring designated institutions and preventing illegal sales, thereby enhancing the authority of medical insurance regulation [2] - The transition from sales regulation to usage regulation aims to create a more transparent and ethical pharmaceutical industry environment [2]