Core Insights - The National Healthcare Security Administration (NHSA) has effectively utilized a unified medical insurance information platform to identify and address multiple cases of abnormal data, showcasing the empowering role of data in regulatory oversight [1] Group 1: Abnormal Data Cases - A physician was found to have prescribed niacinamide at a total amount over 200 times the national average, prompting an investigation into the hospital's medical insurance settlement data [2] - An elderly patient, aged 73, was incorrectly recorded as undergoing "painless egg retrieval" due to a data entry error, while an 86-year-old patient was mistakenly associated with "in vitro fertilization" due to similar coding issues [3] - A doctor was discovered to have issued multiple prescriptions for semaglutide within a minute for different patients, indicating potential fraudulent behavior linked to a medical representative [4] - An analysis revealed over a hundred male patients with billing records for hysteroscopy, which was due to a coding error that confused the local codes for ureteroscopy and hysteroscopy [5] Group 2: Regulatory Actions and Recommendations - The NHSA's flying inspection team confirmed that the medical insurance fund was not harmed and mandated immediate technical corrections from the hospitals involved [6] - The cases highlighted deficiencies in data quality management at designated medical institutions, emphasizing the need for strict pre-upload audits and dynamic daily checks [7] - It is recommended that medical institutions and healthcare departments collaborate closely to enhance monitoring and management of data quality, ensuring the protection of public healthcare funds [7]

Core Insights - The article discusses the significant advancements and reforms in China's medical insurance system during the "14th Five-Year Plan" period, emphasizing the focus on improving public health and reducing medical costs for citizens [1][2]. Group 1: Medical Insurance Coverage - By 2024, the number of people covered by basic medical insurance is expected to reach 1.327 billion, with a stable participation rate of around 95% during the "14th Five-Year Plan" [1][2]. - Nearly 20 billion medical insurance reimbursements are anticipated from 2021 to 2024, with 2024 figures projected to be 1.6 times that of 2020 [2]. Group 2: Support for Specific Demographics - As of June this year, 253 million people are enrolled in maternity insurance, with cumulative expenditures reaching 438.3 billion yuan, benefiting over 96.14 million instances [2]. - The long-term care insurance system is being established, with 190 million participants expected by the end of 2024, and over 95% of village clinics included in the insurance network [2]. Group 3: Healthcare Accessibility and Efficiency - The number of designated medical institutions for insurance has reached 1.1 million, and the direct settlement rate for cross-province hospitalizations is around 90% [3][5]. - The implementation of a unified national medical insurance information platform has improved service efficiency, with over 1.236 billion people using medical insurance codes for direct settlement [4][5]. Group 4: Fund Security and Regulation - The cumulative recovery of medical insurance funds has reached 104.5 billion yuan during the "14th Five-Year Plan," with a total fund balance of 3.86 trillion yuan expected by the end of 2024 [6][7]. - The National Medical Insurance Bureau has intensified supervision and regulation, conducting inspections on 335,000 medical institutions and recovering 16.13 billion yuan in funds in the first half of this year [6][7].