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"。 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。 ...

交叉内审：健全"常态化监督"内控闭环。建立"日常+专项"双轨内审机制，组织各业务股室交叉检查经 办资料完整性、业务办理时效性及签字审批规范性。8月20日开展的专项交叉检查中，高效发现并整改 问题13条立即整改13条，以"晒资料、互监督"倒逼内控要求落地见效。 制度筑基。构建"全流程规范"内控框架。今年以来，健全内控管理制度框架，细化参保登记、基金结 算、医疗救助、稽核管理、财务支付等业务流程经办规范，明确各岗位职责边界与风险点防控措施，实 现"事事有标准、步步有依据"，从源头防范经办漏洞，有效化解操作风险，切实保障医保基金安全与参 保人员合法权益。 今年以来，扶风县医保经办中心聚焦医保经办领域内控管理提质增效，以"防风险、提效能、优服务"为 核心目标，通过制度、科技、流程、队伍、监督、宣传六大维度协同发力，构建全链条、立体化内控体 系，既保障了医保基金安全，又显著提升了群众服务满意度。 科技赋能：打造"实时化预警"监管模式。搭建智能监控平台，对参保登记、医保关系转移接续、费用审 核、基金结算、智能审核、信息管理等所有医保经办业务环节等关键环节实时动态监测，通过智能预警 及时识别不合理经办行为，将风险隐患消灭在 ...

Core Viewpoint - The article discusses the implementation of a new payment reform in China's healthcare system, focusing on a disease-based payment model to enhance efficiency and control costs in medical services [1][2]. Summary by Sections Payment Reform Overview - The National Healthcare Security Administration (NHSA) has introduced the "Interim Measures for the Management of Disease-Based Payment" to promote a multi-faceted payment reform primarily based on disease categories [1]. - The new measures will establish a dynamic adjustment mechanism for disease grouping schemes, with adjustments occurring approximately every two years [1][2]. Disease-Based Payment Mechanism - Disease-based payment involves grouping diseases or calculating values to implement a "bundled payment" system for medical institutions [2]. - The NHSA has been actively promoting disease-based payment for inpatient medical expenses, focusing on two pilot projects: Diagnosis-Related Groups (DRG) and Disease-Based Value Payment (DIP) [2]. - Adjustments to the DRG grouping scheme will maintain stability in major diagnostic categories while focusing on core and detailed subgroup adjustments [2]. Key Policies and Measures - The new measures clarify policies, key technologies, core elements, and supporting measures related to disease-based payment, emphasizing rigid total budget management [2]. - The NHSA will incorporate disease-based payment requirements into agreement management, enhance monitoring and evaluation of reform effectiveness, and strengthen fund supervision [2]. Special Case Mechanism - A "special case negotiation" mechanism has been established to support medical institutions in treating complex and severe patients, allowing for reasonable use of new drugs and technologies [3]. - Cases eligible for special negotiation include those with long hospital stays, high resource consumption, and complex conditions that do not fit standard payment models [3]. Impact on Medical Institutions - The shift from fee-for-service to disease-based payment encourages medical institutions to control costs while still generating revenue [5]. - Institutions can apply for special case negotiations for patients requiring extensive resources or new treatments, ensuring adequate care [5]. Impact on Patients - The reform does not alter the patient discharge settlement experience, and patients may see a reduction in out-of-pocket expenses due to fewer unnecessary medical services [6]. - The NHSA has not imposed restrictions on hospital stays, and any coercive practices by medical institutions regarding discharge will be strictly addressed [6].

Group 1: Medical Insurance Development - The National Medical Security Administration emphasizes empowering the pharmaceutical industry and implementing measures to support high-quality development of innovative drugs [1][2] - By mid-2025, significant progress is expected in medical security, including an increase in the number of people covered by maternity insurance to 253 million and maternity insurance benefit expenditures reaching 67.832 billion yuan in the first half of the year [1] - The meeting highlights the need for a comprehensive adjustment of the national medical insurance drug catalog and the establishment of a commercial health insurance innovative drug catalog [2] Group 2: Maternity Insurance and Long-term Care - The meeting encourages regions to include flexible employment workers, migrant workers, and new employment forms in maternity insurance coverage, while also exploring basic service packages for prenatal check-ups [3] - Long-term care insurance will be fully implemented, with a focus on planning and configuring designated long-term care service institutions and encouraging commercial insurance products that align with long-term care services [3] Group 3: Digital Transformation in Medical Insurance - The meeting calls for a shift in medical insurance from passive payment to active empowerment, focusing on health investment rather than disease compensation [3] - There is an emphasis on integrating medical insurance with technology to promote new medical services, AI health management, and smart elderly care [3]

Group 1: Medical Insurance Development - The National Medical Insurance Administration emphasizes empowering the pharmaceutical industry and implementing measures to support high-quality development of innovative drugs [1][2] - By mid-2025, significant progress is expected in medical insurance, including an increase in the number of insured individuals under maternity insurance to 253 million and total maternity insurance benefits expenditure reaching 67.832 billion [1] - The meeting highlights the need for a comprehensive adjustment of the national medical insurance drug catalog and the establishment of a commercial health insurance innovative drug catalog [2] Group 2: Maternity Insurance and Long-term Care - The meeting encourages regions to include flexible employment workers, migrant workers, and new employment forms in maternity insurance coverage, while also exploring basic service packages for prenatal check-ups [3] - There is a push for the implementation of long-term care insurance, with a focus on planning and supporting long-term care services at the community level [3] - The meeting calls for the integration of long-term care services with commercial insurance products to enhance accessibility and suitability of care [3] Group 3: Digital Transformation in Medical Insurance - The meeting aims to transition the medical insurance system from passive payment to proactive empowerment, focusing on health investment rather than just disease compensation [3] - There is an emphasis on promoting research in disease prediction modeling, pharmacoeconomics, and disease attribution analysis in collaboration with medical institutions and research organizations [3] - The integration of technology in medical insurance is encouraged to foster new medical services, AI health management, and smart elderly care [3]

Group 1 - The core viewpoint of the articles highlights significant investment activities by major institutional investors in Q2 2025, particularly focusing on sectors like healthcare, steel, real estate, and technology [1][2][6] - Berkshire Hathaway revealed its "mysterious holdings" by purchasing six new stocks, including UnitedHealth, Nucor Steel, and Lennar, with a total market value exceeding $3.6 billion at the end of the quarter [2][3] - Li Lu's Himalaya Capital re-entered Pinduoduo as its second-largest holding, indicating a stronger confidence in Chinese e-commerce, while also reducing its stake in Bank of America [4][5] Group 2 - Several prominent hedge funds, including Appaloosa and Scion, also invested in UnitedHealth, which has seen a significant stock price decline of over 45% since April 1, 2025 [3] - Major institutions like Hillhouse, Bridgewater, and JPMorgan increased their positions in technology stocks, capitalizing on the market downturn, with notable investments in Nvidia, Meta, and Google [6][7] - Vanguard, as one of the largest asset management firms, reported a total U.S. stock holding value of $6.18 trillion, with its top five holdings being Nvidia, Microsoft, Apple, Amazon, and Meta, reflecting a strong bullish sentiment towards the tech sector [7]

□本报记者 王雪青 其中，医疗保险巨头联合健康目前属于困境阶段。从今年4月1日至8月14日，公司股价已下跌超45%。 值得注意的是，二季度出手联合健康的不止伯克希尔，买家还包括多家知名对冲基金，例如大卫·泰珀 旗下Appaloosa、"大空头"原型迈克尔·伯瑞旗下Scion以及被称为"量化之王"的文艺复兴科技，还有索罗 斯基金等。相关机构买入的消息披露后，联合健康8月15日涨超10%。 此外，今年二季度，伯克希尔减持苹果2000万股，减仓幅度约为6.67%，苹果仍为第一大重仓股；伯克 希尔还减持美国银行逾2630万股，减持幅度约为4.17%。伯克希尔在二季度还卖出了2家通讯公司股 票，减持特许通讯，清仓T-MOBILE US。 截至北京时间8月15日，美股机构投资者2025年二季度持仓报告基本披露完毕。 中国证券报记者梳理了包括巴菲特旗下伯克希尔·哈撒韦、李录旗下喜马拉雅资本、高瓴旗下HHLR、高 毅、景林、桥水、橡树资本、老虎环球基金、柏基投资、著名对冲基金经理大卫·泰珀旗下的 Appaloosa、"大空头"原型迈克尔·伯瑞的Scion，以及先锋领航、贝莱德、摩根大通等知名投资机构的持 仓情况。 总体来说， ...

Group 1 - The core viewpoint of the articles highlights the innovative approaches taken by the Wulian County Medical Insurance Bureau to enhance public understanding and accessibility of medical insurance policies through community engagement and creative outreach methods [1][2][3] Group 2 - Wulian County has implemented a "Double Hundred" initiative, integrating medical insurance matters into daily life through entertaining and easily understandable cultural programs, such as public screenings of films and traditional performances [2] - The county has conducted 53 public summer activities, reaching over 100,000 people, to promote medical insurance policies and ensure they are well understood by the community [2] - As a pilot county for medical insurance policy promotion on Douyin (TikTok), Wulian County has launched a "Live Streaming Policy" service model, hosting 196 live sessions since 2022, engaging 350,000 participants and addressing over 5,600 inquiries [3]

Core Viewpoint - The new regulations from the National Medical Insurance Administration (NMIA) establish a dynamic adjustment mechanism for disease-based payment schemes, which will be adjusted every two years to align with clinical developments [1][2]. Group 1: Payment Mechanism - The disease-based payment system includes two forms: Diagnosis-Related Group (DRG) payment and Disease Indicator Point (DIP) payment [1]. - The DRG grouping will focus on adjusting core and detailed groups while maintaining stability in major diagnostic categories [1]. - The DIP disease library adjustments will emphasize core and comprehensive disease types [1]. Group 2: Special Case Mechanism - The new regulations introduce a separate section for the "special case single negotiation" mechanism, allowing for cases that are not suitable for standard disease payment, such as long hospital stays or complex critical conditions [2]. - The NMIA aims to streamline the reporting process for special cases, enhancing efficiency and reducing the complexity of required documentation [2]. - This reflects the NMIA's commitment to support medical institutions in the rational use of new drugs and technologies for treating complex patients [2]. Group 3: Historical Context - The pilot reform of the disease-based payment system was initiated by the NMIA in 2019 and has since covered all coordinated areas [3].

Core Viewpoint - The significant rise in UnitedHealth Group's stock price, driven by Berkshire Hathaway's substantial investment, reflects market confidence in the company's long-term potential despite recent challenges [1][2]. Group 1: Stock Performance - On August 15, UnitedHealth's stock surged by 11.98%, reaching its highest point since July 2025 [1]. - Berkshire Hathaway purchased 5.04 million shares of UnitedHealth, valued at approximately $1.572 billion, marking its first investment in the healthcare insurance sector since 2010 [1]. Group 2: Market Context - UnitedHealth faced several challenges, including lowered profit expectations, the resignation of its CEO, and an investigation by the U.S. Department of Justice regarding its billing practices [1]. - The company experienced a nearly 50% stock price drop in the second quarter due to these issues, including a violent incident involving an executive [1]. Group 3: Investment Strategy - Berkshire Hathaway's investment is seen as a classic example of value investing, where the firm identifies long-term potential during periods of market pessimism [2]. - The ongoing focus on healthcare costs and adjustments in UnitedHealth's business model suggest potential for future growth, despite short-term challenges [2]. - Investors are encouraged to consider the company's long-term stability and competitive advantages in the U.S. healthcare insurance market [2].