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 ...

Core Points - The article discusses situations where medical insurance (医保) does not provide reimbursement for medical expenses, highlighting six specific scenarios [2][4][5][7]. Group 1: Situations Where Medical Insurance Does Not Cover Expenses - Work-related injuries are covered by work injury insurance, not medical insurance [2]. - Medical expenses from accidents caused by third parties, such as traffic accidents or fights, are not covered unless the responsible party is identified [2]. - Public health services funded by the government, such as free vaccinations and disease prevention, are not reimbursed by medical insurance [2][4]. - Medical expenses incurred while receiving treatment abroad are not covered by medical insurance [4]. - Preventive health measures, such as routine check-ups and wellness treatments, are not included in the coverage [4]. - Only expenses listed in the three major directories (medical insurance drug directory, medical treatment project directory, and medical service facility directory) are eligible for reimbursement [5][7]. Group 2: The Three Major Directories of Medical Insurance - The drug directory includes: - Class A drugs, which are fully reimbursed [8]. - Class B drugs, which require a personal contribution of 10% or 14% [8]. - Non-reimbursable drugs, often expensive or for rare diseases, are excluded from coverage [8]. - The medical treatment project directory includes necessary and effective clinical treatment projects, but excludes cosmetic procedures and certain fees [9]. - The medical service facility directory covers essential services provided by designated medical institutions, but excludes non-essential services like entertainment fees [9].

Group 1 - The stock price of Chuangyue Huikang closed at 5.96 yuan on August 5, 2025, with an increase of 0.34% compared to the previous trading day [1] - The company reported a trading volume of 60.64 million shares and a transaction amount of 361 million yuan, with a turnover rate of 3.97% [1] - Chuangyue Huikang, established in 1997 and listed in 2015, operates in the software development industry, focusing on smart healthcare, smart sanitation, medical insurance, health, and elderly care information solutions [1] Group 2 - In 2024, the company's revenue composition indicated that the medical sector accounted for 93.25%, while the non-medical sector made up 6.75% [1] - On the evening of August 5, the company announced that its second-largest shareholder, Philips, plans to reduce its holdings by up to 46.33 million shares, representing 3% of the total share capital, with a proposed reduction amounting to approximately 276 million yuan based on the closing price [1] - For the first quarter of 2025, the company reported a revenue of 290 million yuan, a year-on-year decrease of 22.67%, and a net loss of 15.64 million yuan [1] Group 3 - On August 5, the net inflow of main funds was 8.47 million yuan, with a cumulative net inflow of 22.62 million yuan over the past five days [2]

Summary of Key Points from Conference Call Industry or Company Involved - The discussion primarily revolves around the **A-share market** and the **Hong Kong innovative pharmaceutical sector**. Core Insights and Arguments 1. **Market Sentiment and Adjustments** The recent pullback in the Hong Kong innovative pharmaceutical sector significantly impacts market sentiment, indicating potential overall market adjustment risks [1][2][8] 2. **Currency Impact on A-shares** There is a notable negative correlation between the offshore RMB exchange rate and A-share performance. Recent RMB depreciation has been a key factor suppressing A-shares [1][3][10] 3. **Technical Analysis of Shanghai Composite Index** The Shanghai Composite Index faces mid-line resistance at 3,700-3,800 points and 4,000-4,100 points, with technical indicators suggesting a potential daily level adjustment until mid-August [1][5][11] 4. **Market Drivers** Current market trends are primarily driven by DDM model factors, including increased risk appetite, declining risk-free rates, and ample liquidity, despite economic recovery not meeting expectations [1][6] 5. **Short-term Support Levels** Key short-term support levels include gaps at 3,536 and 3,517 points, with the 60-day moving average serving as critical support if adjustments are significant [1][7][19] 6. **Sector Performance** The pharmaceutical, communication, and computer sectors remain advantageous, while cyclical resource stocks are expected to improve in the long term despite short-term weakness [1][12][23] 7. **Market Emotion and Future Trends** Despite recent index pullbacks, market sentiment has not significantly deteriorated, indicating potential investment opportunities in specific growth sectors [1][13] 8. **Current State of Construction and Real Estate Sectors** The construction, real estate, and building materials sectors are currently event-driven rather than driven by industry recovery, suggesting a lack of sustainability in recent gains [1][14] 9. **Transportation and Oil & Gas Sector Performance** Recent underperformance in the transportation and oil & gas sectors indicates that even dividend assets struggle to maintain stability in the current market environment [1][15] 10. **Future Market Predictions** The market is expected to undergo adjustments over the next 10 trading days, with potential support at the 3,536-point level. A rebound could lead to a larger top structure by late August [1][16][17][19] 11. **Investment Strategy Recommendations** It is advised to maintain a wait-and-see approach in the short term, with potential opportunities for mid-line accumulation near the 60-day moving average [1][20][19] 12. **Current Market Style and Sector Themes** The market is at a critical threshold for style shifts, with growth and value styles showing signs of potential switching. Close monitoring of momentum changes is necessary [1][21][22] 13. **Industry Scoring and Recommendations** Despite potential style shifts, sectors like pharmaceuticals, communications, and computing remain top-rated. Cyclical resource stocks are still recommended due to improved expectations [1][23] 14. **Thematic Investment Opportunities** Several thematic indices, such as the Traditional Chinese Medicine Index and AI Machine Index, are highlighted as having strong performance potential, particularly in the current market environment [1][24] Other Important but Possibly Overlooked Content - The correlation between the performance of the Hong Kong innovative pharmaceutical sector and the A-share market indicates that market movements are heavily influenced by sentiment rather than fundamental changes [1][9] - The potential for a significant market adjustment if the upward trend is not maintained, particularly in light of external pressures such as US inflation data and cross-border capital flows [1][18]

Group 1 - The core viewpoint of the article highlights the achievements and ongoing efforts of China's healthcare system under the "14th Five-Year Plan," focusing on universal health insurance coverage and improving medical services for the population [1][8] Group 2 - As of the end of 2024, 715 million people are expected to participate in the long-term care insurance system, with initiatives to optimize nursing resources and include over 95% of village clinics in the insurance network [3] - The establishment of a comprehensive outpatient mutual aid guarantee mechanism is underway, with over 1.1 million designated medical institutions across more than half of the regions in the country by June 2025 [4] - A total of 402 new and effective drugs have been added to the insurance directory since the beginning of the "14th Five-Year Plan," alongside reforms in payment methods and support for medical technology innovation [5] - The government is intensifying regulatory measures to combat fraud in the healthcare system, ensuring the safety of medical insurance funds and implementing strict drug traceability protocols [6]

Core Viewpoint - The article discusses the importance of medical insurance (医保) in people's lives, highlighting the benefits and complexities of reimbursement processes, and argues that despite some concerns, it is worthwhile to maintain insurance coverage [1][8]. Group 1: Hospitalization Reimbursement - For employees under the employee medical insurance scheme, hospitalization in a tertiary hospital can have a reimbursement rate of 70%, meaning for a 100,000 yuan expense, the individual pays 30,000 yuan while the insurance covers 70,000 yuan [3]. - The reimbursement rate increases to 80% for secondary hospitals and can reach 90% for individuals over 70 years old, indicating that older patients and those using lower-tier hospitals benefit more from the insurance [3]. - The maximum reimbursement for serious illnesses can range from 200,000 to 500,000 yuan, providing significant financial relief for families dealing with severe health issues [3]. Group 2: Outpatient Reimbursement Changes - Prior to April 2020, outpatient expenses were primarily out-of-pocket, but recent reforms have allowed outpatient costs to be included in the insurance reimbursement system [3]. - In community hospitals, outpatient expenses can be reimbursed at 50%-60%, significantly reducing the personal payment burden [3]. - For chronic diseases like hypertension and diabetes, the reimbursement rate has been raised to over 65%, with no minimum payment threshold [3]. Group 3: Benefits for Urban and Rural Residents - Urban and rural residents pay approximately 400 yuan annually for insurance, which covers about 50% of outpatient costs, allowing them to "break even" after just two visits [5]. - Hospitalization benefits are also substantial, with reimbursement rates of 70% in tertiary hospitals and up to 85% in community health centers [5]. - The insurance system encourages patients to seek treatment in community settings for minor ailments while reserving hospitals for more serious conditions [5]. Group 4: Reasons for Perceived Low Reimbursement - Not all medical expenses are covered; expenses for drugs not listed in the insurance directory must be paid out-of-pocket, with over 14,000 types of drugs excluded [6]. - High deductibles for certain hospitals can deter patients from seeking reimbursement for minor ailments, as they may not meet the minimum threshold for claims [6]. - The reimbursement rates vary by hospital tier, with community hospitals generally offering higher reimbursement rates compared to tertiary hospitals [6]. Group 5: Overall Value of Medical Insurance - Despite concerns about reimbursement amounts, the overall value of medical insurance remains high, with employee insurance covering 2-3 times the amount paid by individuals, and resident insurance covering 50%-60% of medical expenses [8]. - The article emphasizes the importance of maintaining insurance coverage, as the premiums paid today can provide substantial financial protection in the future [8].