经济观察报 记者 张铃 2026年2月28日是第19个国际罕见病日，主题为"不止罕见"（More than you can imagine）。在全球， 7400余种罕见病影响着超过4.2亿人，中国也有超2000万罕见病患者。 中国高度重视罕见病防治与保障工作，近年来有关方在政策法规体系、临床诊疗水平、药品供应机制、 社会保障体系等方面持续探索完善，不过还有一些呼吁和政策构想有待落地，其中最具代表性的当为成 立罕见病专项基金。 近一年来，包括对外经济贸易大学教授孙洁、浙江省衢州市中医医院副院长陈玮、湖北省咸宁市中心医 院感染管理办公室主任王雪静在内的多位全国两会代表委员都曾提出成立罕见病专项基金的建议。在新 一年国际罕见病日和全国两会来临之际，罕见病专项基金也是罕见病领域最受关注的话题之一。 多位受访专家认为，只有建立多方筹资、多层次支付的保障机制，才能解决罕见病高值药的支付问题。 其中，探索建立专项基金，是多层次医疗保障支付体系中的重要一环，也是解决罕见病保障"最后一公 里"的重要路径。 地方探索 与常见病不同，罕见病往往具有残酷的不可逆性，药物治疗往往伴随患者终身，且具有不可替代性。一 旦因经济压力断药，患 ...

缘何沦为"药贩子"敛财工具 医保基金是广大群众的"看病钱""救命钱"，然而却有不法分子利欲熏心将手伸向了这里。他们通过精心设计瞄准老年人为目标，疯狂骗取医保基金，触 碰法律红线。 近日，上海检察机关曝光了两起医保诈骗大案，涉案金额合计超千万元。那么，如此惊人数字的背后，究竟藏着怎样隐蔽的骗保黑幕？一张普通的医保 卡，又为何会沦为不法分子的敛财工具？ 普通医保卡 据上海市浦东新区人民检察院指控，2020年1月至2024年3月间，被告人王某等人以非法占有为目的，采取收购他人使用医保卡在医院虚开的药品，或采 取直接使用他人医保卡到医院虚开药品的方式，骗取国家医保统筹基金860余万元。 那么，如此大规模的骗保行为，究竟是如何一步步掩人耳目实施的呢？ 上海市浦东新区人民检察院检察官 胡锦萍：王某有在医院门口收药的行为，有在医院门口搭讪老太太的行为，从被告人王某的身上查获了十几本医保 卡。 搭讪就医老人 逐步组建起"药农"队伍 检察官介绍，王某以医院及医院周边为目标区域，通过搭讪就医老人的方式，逐步拉拢、组建起自己的"药农"队伍。 上海市浦东新区人民检察院检察官助理 张洁：在上海浦东新区的各大医院和社区卫生服务中心，他先 ...

国家医疗保障局令第7号 《医疗保障基金使用监督管理条例实施细则》已经2026年2月12日国家医疗保障局局务会议审议通过， 现予以公布，自2026年4月1日起施行。 局长：章轲2026年2月12日 医疗保障基金使用监督管理条例实施细则 第一章总则 第一条根据《中华人民共和国社会保险法》《中华人民共和国基本医疗卫生与健康促进法》《医疗保障 基金使用监督管理条例》(以下简称条例)《社会保险经办条例》等有关法律、行政法规，制定本实施细 则。 第二条各级医疗保障行政部门应当加强对纳入医疗保障基金支付范围的医疗服务行为、医药费用的监 督，组织开展医疗保障基金使用监督检查，依法查处医疗保障领域违法违规行为。 医疗保障行政部门应当规范医疗保障经办业务，加强对服务协议订立、履行等情况的监督。 医疗保障行政部门建立医疗保障基金智能监督管理制度，健全事前、事中、事后相结合，全流程、全领 域、全链条的智能监管体系。 第三条各级医疗保障行政部门应当建立政府监管、社会监督、行业自律和个人守信相结合的监督体系， 加强对医疗保障基金使用的监督。 第二章基金使用 医疗保障经办机构应当建立健全业务、财务、安全和风险管理制度。县级以上医疗保障经办 ...

2025年，兵团医疗保障局强化部门协同，积极开展日常检查、专项抽查、联合检查、飞行检查等多种形 式的检查，并同步应用医保智能监管系统、反欺诈大数据监测平台，对定点医药机构进行立体式、全覆 盖监管，不仅实现了对传统骗保行为的精准识别，更将监管触角延伸至门诊慢特病、DRG付费等领 域，有效防范了冒名就医（购药）、空刷套现、串换药品（项目）等欺诈骗保行为的发生。 同时，兵团还加快推进药品耗材追溯码的采集应用，精准打击"回流药"等乱象，对违规定点医药机构通 过解除协议、行政处罚等方式，形成查处一案、警示一片的强力震慑。2025年，兵团对100家违规定点 医药机构解除了医保服务协议，作出行政处罚36例，纳入信用管理重点监控45家，支付资格记分1017 人，对66名参保人给予签订承诺书、提高起付线等分级处理。 本报乌鲁木齐讯（全媒体记者 郑娅莉） "您好，您最近几个月的降压药已经开过了，不能再开了。"1月 22日，企业退休职工徐大爷在八师石河子市一家定点零售药店购药时，工作人员根据系统预警向徐大爷 作出提示。原来，徐大爷前段时间在另外一家药店一次性购买了3个月的降压药，系统对这一异常行为 进行了实时识别。 "当参保患者到 ...

Core Insights - The implementation of the new National Medical Insurance and Commercial Health Insurance Drug Directories in Hunan marks a significant advancement in the multi-tiered medical security system, benefiting 3,253 types of insurance drugs for the insured population [1][8] Group 1: Drug Directory Optimization - The new National Medical Insurance Directory has added 114 high-value drugs while removing 29 low-value drugs, resulting in a total of 3,253 drugs in Hunan's directory. The new additions focus on oncology, chronic diseases, and rare diseases, addressing the accessibility of essential medications [2][9] - To ensure continuity of medication for patients, a 6-month reimbursement transition period is set for removed negotiation drugs, along with an optimized "dual-channel" management mechanism that includes 334 drugs, with 70 new additions [2][9] Group 2: Payment Rules and Mechanisms - Hunan has clarified tiered reimbursement rules, introducing a "self-payment ratio" column in the new directory. Class A drugs and 892 types of traditional Chinese medicine will have zero self-payment, while the self-payment ratio for Class B drugs will be determined by expert review [3][10] - A "special case negotiation" mechanism has been established to support the reimbursement of innovative drugs outside the directory, addressing challenges related to the use of innovative drugs in hospitals and payment limitations for complex cases [3][10] Group 3: Supply Assurance and Accessibility - To ensure timely supply of newly added drugs, Hunan mandates that by the end of December 2025, new drugs must be listed, and by February 2026, medical institutions must ensure availability through procurement channels. Negotiated drugs will not be restricted by "one product, two regulations" [4][11] - The dual-channel supply system allows for both medical institutions and retail pharmacies to provide 334 types of drugs, with a unified electronic prescription center enhancing service convenience [4][11] Group 4: Commercial Insurance Directory - The first version of the Commercial Health Insurance Innovative Drug Directory includes 19 high-value drugs that exceed basic insurance coverage, focusing on advanced treatments such as CAR-T therapy and rare disease medications [5][12] - A "three exclusions" policy has been implemented for the commercial insurance directory, ensuring that these drugs are not included in medical institution drug usage assessments, centralized procurement monitoring, or DRG/DIP payment weight calculations [5][12] Group 5: Price Reduction and Patient Burden Relief - Following the implementation of the dual directories, prices for many nationally negotiated drugs have significantly decreased, directly benefiting patients. For instance, the monthly treatment cost of the newly listed domestic innovative drug Senapali capsules dropped from approximately 17,300 yuan to 9,300 yuan [6][13] - Other drugs, such as Jin Sai growth hormone, have also seen substantial price reductions, with annual treatment costs for a 30 kg child decreasing from about 120,000 yuan to around 30,000 yuan, greatly alleviating family financial burdens [7][13]

Core Viewpoint - The National Healthcare Security Administration (NHSA) has issued a notice outlining nine key tasks for the regulation of the medical insurance fund in 2026, emphasizing the importance of maintaining a high-pressure regulatory environment to ensure the safety of the medical insurance fund [1][2]. Group 1: Regulatory Measures - The notice emphasizes the continuation of special rectification of prominent issues in medical insurance fund management, with local healthcare departments required to ensure accountability at the highest level and implement multiple measures to enhance rectification efforts [1]. - A comprehensive expansion and quality improvement of flying inspections will be promoted, covering all provinces and various stakeholders, including designated medical institutions and insured individuals, across different types of insurance [1]. Group 2: Technological Innovations - The notice highlights the exploration of innovative applications of cutting-edge technologies such as artificial intelligence in regulatory practices, including the development of big data regulatory models to address challenges associated with DRG/DIP payment methods [2]. - The integration of artificial intelligence with imaging recognition is proposed to accurately identify irregularities in implanted medical materials and fraudulent medical practices [2]. Group 3: Systematic Improvements - The notice calls for the continuous improvement of a comprehensive intelligent regulatory system, aiming for over 70% of designated medical institutions to be connected to a pre-reminder system by the end of 2026 [2]. - It also emphasizes the need to establish long-term regulatory mechanisms, including the development of detailed implementation rules for the supervision of medical insurance fund usage and the management of personal accounts in retail pharmacies [2].

Group 1: Healthcare Policy Initiatives - The Hunan Provincial Medical Security Work Conference outlined seven key tasks for 2026, focusing on enhancing public healthcare access and benefits [1] - The province will implement a "zero out-of-pocket" policy for childbirth expenses covered by medical insurance starting July 1, 2026, and will expand maternity insurance coverage to include flexible workers and migrant workers [1] - A long-term care insurance system will be initiated for insured employees in the second half of the year, along with improvements to rehabilitation and palliative care payment models [1] Group 2: Medical Governance and Regulation - Strengthening medical governance through adjustments in the medical insurance catalog to improve reimbursement rates and address unreasonable hospitalization rates [1] - The province aims to enhance fund supervision by addressing issues like fund misappropriation and excessive medical treatments, and will develop a unified knowledge base for pre-approval and real-time audits [1] - The establishment of a "Regulatory Xiangjun" brand to promote effective oversight in the healthcare sector [1] Group 3: Digital Transformation and Service Optimization - The province is advancing digitalization in healthcare services, including online processing for chronic diseases and high-frequency medical matters, aiming for a more efficient service experience [2] - The introduction of the "Xiang Medical Insurance Heart Service" to enhance convenience in payment methods and service accessibility [2] - Promotion of cross-departmental data sharing and the development of a cloud-based medical insurance system to improve service delivery [2] Group 4: Maternal and Child Health Services - The introduction of six "Fertility-Friendly Service Packages" to address the health needs of women and children throughout their life cycles, aimed at reducing the costs of childbirth and caregiving [3][4] - Each service package includes both basic and upgraded personalized services to cater to varying community needs, with a focus on accessibility and precision in service delivery [4] - The initiative is a collaborative effort involving multiple provincial departments to enhance maternal and child health service quality and improve public satisfaction [5]

Core Insights - The Gansu Provincial Medical Security Bureau has been awarded the title of "Advanced Collective in Rural Revitalization" by the Gansu Provincial Party Committee and Government for its contributions to rural revitalization efforts [1] Summary by Sections Achievements - The Medical Security Bureau has implemented central and provincial policies on rural revitalization, focusing on integrating medical security into the strategy [1] - A total of 518,200 low-income individuals have received insurance subsidies amounting to 88.8953 million yuan [1] - Medical expenses totaling 913 million yuan have been reimbursed for 553,200 low-income individuals [1] - The bureau has provided assistance to 27,300 individuals through its application-based aid policy, distributing 102 million yuan in medical aid [1] Future Plans - The bureau aims to enhance the multi-tiered medical security system and ensure the bottom line of medical security for the public [1] - It plans to leverage the "Ten Million Project" experience to contribute further to the comprehensive revitalization of rural areas in Gansu [1]

Core Viewpoint - The government of Guangxi has announced a full subsidy for personal contributions to the urban and rural basic medical insurance for eligible severely disabled individuals starting from 2027, aiming to enhance the social security system for disabled persons in the region [1][2]. Group 1: Policy Details - The subsidy applies to severely disabled individuals who hold a valid disability certificate and are residents of Guangxi, specifically those classified as level one or two [1]. - The government will provide full subsidies for the personal contribution portion of the insurance, with specific guidelines on how to apply for the subsidy based on the individual's status [1][2]. Group 2: Implementation Mechanism - Severely disabled individuals can enjoy the subsidy through an "automatic benefit" system, where local disability associations and healthcare departments coordinate to handle the subsidy without requiring individual applications [2]. - For those who register in a different location from where their disability certificate was issued, a "pay first, reimburse later" method will be used, allowing them to apply for the subsidy after payment [2]. Group 3: Impact on Disabled Individuals - This policy is expected to significantly reduce the medical insurance costs for severely disabled individuals, ensuring they have stable access to basic medical insurance benefits [2].

Core Insights - The article highlights the significant improvements in medical services and insurance coverage in the Twelve Division, particularly focusing on day surgery and maternity insurance benefits for flexible employment workers [2][3][4][5] Group 1: Day Surgery Benefits - The implementation of day surgery insurance payment policies has greatly enhanced patient experience, allowing for surgeries to be completed in under 24 hours, with costs significantly reduced [2] - For example, the cost of cataract surgery has decreased by approximately 1800 yuan per visit due to the introduction of day surgery [2] Group 2: Maternity Insurance Enhancements - Flexible employment workers, such as those running online businesses, will be included in maternity insurance coverage starting in 2025, allowing for reimbursement of medical expenses and a maternity allowance of 158 days for natural births [3][4] - The process for claiming maternity benefits has been streamlined, enabling one-stop service at hospitals and direct deposit of allowances into personal bank accounts [4] Group 3: Chronic and Special Disease Management - Patients with chronic diseases can now handle their medical paperwork locally, eliminating the need to travel to distant hospitals for approvals [4] - The Twelve Division has improved the efficiency of cross-province medical services, with significant numbers of patients utilizing these services in 2025 [5] Group 4: Overall Medical Service Improvements - The overall medical service experience has been enhanced, with reduced need for patients to travel for care, leading to a more reassuring healthcare environment [5] - The collaboration between local and regional medical services has improved, ensuring that more families can access quality healthcare close to home [5]