Core Insights - The article highlights the importance of secondary reimbursement in China's medical insurance system, which is often overlooked by insured individuals, leading to significant financial losses [3][6]. Group 1: Current Status of Secondary Reimbursement - As of the first quarter of 2025, only 27.3% of eligible medical expenses were actually claimed for secondary reimbursement, indicating a lack of awareness among insured individuals [3]. - The secondary reimbursement system is part of a multi-tiered medical insurance framework, including major illness insurance, medical assistance, supplementary medical insurance, and employee personal accounts [4][5]. Group 2: Mechanisms of Secondary Reimbursement - Major illness insurance allows for reimbursement of 50% of medical expenses exceeding 50% of the local per capita disposable income, with no cap on the reimbursement amount [4]. - Medical assistance provided 873 billion yuan in funding in 2024, benefiting nearly 39.67 million people, with additional support for low-income households [4]. - Supplementary medical insurance has been established in 27 provinces, increasing reimbursement rates from 50% to an average of 70% for outpatient services [4]. Group 3: Challenges in Awareness and Application - A survey indicated that only 36% of insured individuals had a basic understanding of secondary reimbursement policies, and only 22% were aware of the specific application process [6]. - The complexity of the application process, requiring various documents and differing policies across regions, contributes to the low application rates [6]. Group 4: Efforts to Simplify Processes - The National Medical Insurance Administration has implemented a one-stop settlement reform, with 219 cities achieving this by June 2025, allowing for automatic calculation and settlement of various insurance claims [7]. Group 5: Maximizing Secondary Reimbursement Benefits - Insured individuals are encouraged to actively seek information about policies, retain all medical receipts, and inquire about eligibility for secondary reimbursement during hospital visits [9]. - Special provisions exist for certain demographics, such as higher reimbursement rates for individuals under 25 and additional benefits for seniors over 65 [9]. Group 6: Future Outlook and Policy Optimization - The 2025 work plan aims to increase the reimbursement rate for major illness insurance, lower the threshold for claims, and simplify application procedures, with a target of raising the application rate to over 50% [11]. - The total scale of the national medical insurance fund reached 3.2 trillion yuan in 2024, with 6.3% allocated for secondary reimbursement, indicating a focus on improving fund efficiency [11].

Core Viewpoint - The article emphasizes the significant advancements in China's healthcare insurance system during the "14th Five-Year Plan" period, focusing on improving coverage, reducing medical expenses for citizens, and enhancing the overall quality of healthcare services [1][2]. Group 1: Universal Coverage - The national basic medical insurance coverage rate has stabilized at around 95% during the "14th Five-Year Plan" period, with nearly 20 billion instances of insurance reimbursement expected from 2021 to 2024 [2]. - The introduction of measures such as allowing newborns to enroll in insurance using their birth certificates and expanding the coverage of maternity insurance aims to enhance accessibility [3]. Group 2: Benefit Expansion - By June 2025, approximately 253 million people are projected to participate in maternity insurance, with cumulative expenditures reaching 438.3 billion yuan, benefiting over 96.14 million instances [3]. - Various medical assistance policies have benefited 673 million rural low-income individuals, alleviating medical expenses by over 650 billion yuan [3]. Group 3: Healthcare Service Improvement - The introduction of the "medical insurance wallet" allows insured individuals to transfer personal account funds to family members for medical expenses, breaking provincial limitations [4]. - The number of designated medical institutions has reached 1.1 million, and the total number of drugs in the insurance catalog has reached 3,159, further reducing the financial burden on citizens [5]. Group 4: Technological Advancements - The establishment of a unified national medical insurance information platform has significantly improved service efficiency, enabling cross-province handling of high-frequency matters [6]. - The regulatory framework for medical insurance funds has been fully established, recovering over 100 billion yuan in misused funds [6]. Group 5: Future Outlook - The National Medical Insurance Administration aims to continue managing and utilizing medical insurance funds effectively, supporting the development of the pharmaceutical industry and contributing to the overall health of the population [7].

Core Insights - The article emphasizes the importance of healthcare insurance in safeguarding the public's health and financial well-being, highlighting the efforts made during the "14th Five-Year Plan" to enhance and expand insurance coverage for all citizens [1] Group 1: Universal Coverage - The national basic medical insurance coverage rate has stabilized at around 95% during the "14th Five-Year Plan," with nearly 20 billion people benefiting from insurance reimbursements from 2021 to 2024 [2] - Innovations such as allowing newborns to enroll in insurance using birth certificates and relaxing household registration restrictions have marked a new phase in universal coverage [3] Group 2: Maternity Insurance Expansion - By June 2025, approximately 253 million people are expected to participate in maternity insurance, with cumulative expenditures reaching 438.3 billion yuan, benefiting 96.14 million people [3] - Nearly 60% of regions have begun directly issuing maternity benefits to insured female employees, with plans to enhance services in maternal and pediatric care [3] Group 3: Major Illness Insurance and Medical Assistance - During the "14th Five-Year Plan," medical assistance policies have benefited 673 million rural low-income individuals, reducing their financial burden by over 650 billion yuan [3] - Full funding for insurance for special hardship groups and orphans ensures that vulnerable populations receive necessary medical coverage [3] Group 4: Expanding Benefit Coverage - The introduction of the "medical insurance wallet" allows insured individuals to transfer personal account funds to family members for medical expenses, breaking provincial limitations [4] - The establishment of a comprehensive outpatient mutual aid mechanism and the inclusion of assisted reproductive services in insurance coverage are part of broader efforts to enhance benefit offerings [4] Group 5: Healthcare Service Upgrades - The number of designated medical institutions has reached 1.1 million, with 435 types of drugs included in centralized procurement, further alleviating the financial burden on citizens [5] - The total number of drugs in the insurance catalog has reached 3,159, reflecting ongoing adjustments to improve healthcare service accessibility [5] Group 6: Digital Transformation in Healthcare - The implementation of a unified national medical insurance information platform has significantly improved service efficiency, allowing for cross-province processing of high-frequency matters [7] - Advanced technologies such as big data and artificial intelligence are enhancing the accessibility of medical insurance services [7] Group 7: Fund Management and Oversight - The healthcare fund regulatory system has been fully established, recovering over 100 billion yuan in misused funds [8] - Comprehensive inspections have covered all regions and types of fund usage, addressing historical issues of fund misappropriation [8] Group 8: Economic Impact of Healthcare Insurance - Cumulative healthcare fund expenditures have reached 12.13 trillion yuan during the "14th Five-Year Plan," providing financial support for both public health and the pharmaceutical industry [9] - The ongoing management of healthcare funds aims to bolster the development of related industries while safeguarding public health [9]

Core Insights - The article emphasizes the continuous improvement of China's basic medical insurance system, aiming to alleviate the medical financial burden on citizens and ensure access to healthcare services [1] Group 1: Coverage and Participation - During the "14th Five-Year Plan" period, the national basic medical insurance participation rate remains stable at around 95%, with nearly 20 billion people benefiting from insurance reimbursements from 2021 to 2024 [2] - The expansion of maternity insurance coverage is highlighted, with 253 million people participating and a total fund expenditure of 438.3 billion yuan, benefiting 96.14 million people [2] Group 2: Benefit Enhancements - The introduction of the "medical insurance wallet" allows insured individuals to transfer personal account funds to family members for medical expenses, breaking provincial limitations [4] - The number of designated medical institutions has reached 1.1 million, and the total number of drugs in the insurance catalog has reached 3,159, further reducing the medical burden on citizens [5] Group 3: Service Upgrades - The establishment of a unified national medical insurance information platform has significantly improved service efficiency, allowing for cross-province handling of high-frequency matters [6] - The implementation of data and AI technologies has enhanced the accessibility of medical insurance services and reduced fraudulent activities [7] Group 4: Financial Management - The cumulative expenditure of the medical insurance fund has reached 12.13 trillion yuan, providing financial support for both healthcare and the pharmaceutical industry [9] - The regulatory framework for medical insurance funds has been fully established, with over 100 billion yuan recovered from fraudulent activities [8]

Core Insights - The article emphasizes the continuous improvement of China's basic medical insurance system, aiming to alleviate the medical financial burden on citizens and ensure access to healthcare services [1] Group 1: National Insurance Coverage - During the "14th Five-Year Plan" period, the national basic medical insurance coverage rate has stabilized at around 95%, with nearly 20 billion instances of insurance reimbursement from 2021 to 2024 [2] - The introduction of measures such as allowing newborns to enroll in insurance using birth certificates and expanding the coverage of maternity insurance aims to enhance accessibility [2] - By June 2025, approximately 253 million people are expected to participate in maternity insurance, with cumulative expenditures reaching 438.3 billion yuan, benefiting over 96.14 million individuals [2] Group 2: Medical Assistance and Support - The medical assistance policies during the "14th Five-Year Plan" have benefited 673 million rural low-income individuals, reducing their financial burden by over 650 billion yuan [2] - Full funding for insurance coverage for vulnerable groups, including orphans and those on minimum living allowances, is being implemented to ensure comprehensive medical coverage [2] Group 3: Expansion of Benefits - The introduction of the "medical insurance wallet" allows insured individuals to transfer personal account funds to family members for medical expenses, breaking provincial limitations [4] - The establishment of a comprehensive outpatient mutual aid mechanism and the inclusion of assisted reproductive services in insurance reimbursement are part of the ongoing expansion of medical benefits [4] Group 4: Service Upgrades - The national medical insurance information platform has achieved millisecond-level response times, with 644,000 cross-provincial designated medical institutions [6] - The integration of big data and artificial intelligence technologies is enhancing the accessibility and convenience of medical insurance services for citizens [6] Group 5: Fund Management and Oversight - The medical insurance fund regulatory system has been fully established, recovering over 100 billion yuan in misused funds [8] - Continuous efforts are being made to combat fraud and illegal activities within the medical insurance system, including the implementation of tracking codes [8] Group 6: Economic Impact - Cumulatively, the medical insurance fund has disbursed 12.13 trillion yuan, providing financial support for both healthcare and the pharmaceutical industry [9] - The management of the medical insurance fund is aimed at safeguarding public health while simultaneously supporting the development of related industries [9]

Core Viewpoint - The article discusses the achievements and future plans of China's medical insurance system during the "14th Five-Year Plan" period, highlighting improvements in coverage, fund management, and the introduction of long-term care insurance [1][3]. Group 1: Medical Insurance Coverage - The national basic medical insurance coverage rate remains stable at around 95%, with a cumulative expenditure of 12.13 trillion yuan, averaging an annual growth rate of 9.1% [1][3]. - By 2024, the number of people covered by basic medical insurance is expected to reach 1.327 billion, with long-term care insurance coverage at 190 million [1][3]. - The direct settlement rate for cross-provincial medical expenses exceeds 90%, and the national medical insurance drug list has been unified, totaling 3,159 types of drugs [1][3]. Group 2: Long-Term Care Insurance - The long-term care insurance system is expected to be implemented nationwide soon, as the current pilot programs have shown positive results [4][7]. - As of June 2025, 253 million people are participating in maternity insurance, with cumulative expenditures of 438.3 billion yuan, benefiting 96.14 million people [6]. - The long-term care insurance aims to alleviate the financial burden of daily care for elderly individuals who have lost their ability to care for themselves, addressing the increasing demand for elderly care services [6][7]. Group 3: Fund Management and Regulation - The medical insurance fund is under increasing pressure, and the focus will be on ensuring fund safety and risk assessment during the "15th Five-Year Plan" period [4][8]. - The reform of payment methods has transitioned from a "post-payment" to a "pre-payment" system, promoting efficiency in medical institutions and reducing patient out-of-pocket expenses by approximately 5% year-on-year [9][10]. - The National Medical Insurance Administration has intensified efforts to combat fraud and misuse of medical insurance funds, recovering 16.13 billion yuan in the first half of the year through inspections of 335,000 medical institutions [10][11]. Group 4: Drug Price Governance - The article emphasizes the importance of drug price governance, with the government supporting market-driven pricing while also maintaining oversight to prevent price manipulation [12][13]. - Since 2018, the government has conducted 10 rounds of centralized drug procurement, covering 435 types of drugs, which has helped lower drug prices and improve accessibility [13][14]. - The National Medical Insurance Administration is committed to ensuring fair pricing practices and encourages public reporting of unusually high drug prices [14].

Core Viewpoint - The article highlights the achievements and future plans of China's medical insurance system during the "14th Five-Year Plan" period, emphasizing the stability and expansion of coverage, the financial support for the healthcare industry, and the ongoing reforms to improve the quality and efficiency of medical services [1][2]. Group 1: Medical Insurance Coverage and Financial Support - The basic medical insurance coverage rate has remained stable at around 95%, with 1.327 billion people enrolled in 2024 [1][3]. - Cumulative medical insurance fund expenditure reached 12.13 trillion yuan, with an annual growth rate of 9.1%, providing robust financial support for healthcare services [1][2]. - Nearly 200 billion medical insurance reimbursements were utilized by patients from 2021 to 2024, marking a 1.6 times increase compared to 2020 [3]. Group 2: Multi-tiered Medical Security System - A multi-tiered medical security system is being established, consisting of a unified medical insurance information platform, basic medical insurance, critical illness insurance, and medical assistance [4]. - As of June 2025, 253 million people participated in maternity insurance, with cumulative expenditures of 438.3 billion yuan [4]. - Long-term care insurance has covered 190 million people, addressing the care needs of disabled individuals [5]. Group 3: Regulation and Management of Medical Insurance Funds - The National Medical Insurance Administration has intensified efforts to regulate medical insurance funds, focusing on reducing fraud and ensuring proper fund usage [6][7]. - In the first half of the year, 335,000 medical institutions were inspected, recovering 16.13 billion yuan in misused funds [7]. - The administration has implemented data-driven approaches to enhance the precision of fund management and fraud detection [7]. Group 4: Drug Price Governance - Drug pricing remains a significant concern, with the government encouraging market-driven pricing while maintaining oversight to prevent price manipulation [9][10]. - Since 2018, ten rounds of centralized drug procurement have been conducted, covering 435 drugs, which has helped lower drug prices and improve accessibility [11]. - The administration has taken measures to address abnormal drug pricing, urging companies to adhere to fair pricing practices [12].

Core Viewpoint - The National Healthcare Security Administration (NHSA) has released the "2024 National Medical Security Development Statistical Bulletin," indicating a stable growth in basic medical insurance coverage and a focus on improving service quality and fund management [2][4]. Group 1: Basic Medical Insurance Coverage - As of the end of 2024, approximately 1.327 billion people are enrolled in basic medical insurance in China, maintaining a coverage rate of 95% [4][5]. - The number of employees covered by medical insurance has increased to 379 million, reflecting a 2.3% growth compared to the previous year [5]. Group 2: Fund Revenue and Expenditure - The total revenue and expenditure of the national basic medical insurance fund (including maternity insurance) for 2024 are projected to be approximately CNY 3.49 trillion and CNY 2.98 trillion, respectively [4]. - The employee medical insurance fund revenue is estimated at CNY 2.373 trillion, a 3.5% increase year-on-year, while expenditures are expected to reach CNY 1.910 trillion, marking a 7.6% increase [7][11]. Group 3: Medical Treatment and Benefits - The number of treatment beneficiaries under employee medical insurance is projected to reach 5.308 billion in 2024, a 9.9% increase from the previous year [13]. - The average hospitalization cost for employee medical insurance participants is estimated at CNY 11,707, with varying costs across different levels of medical institutions [15][18]. Group 4: Resident Medical Insurance - By the end of 2024, the number of participants in urban and rural resident medical insurance is expected to reach approximately 947 million [20]. - The revenue for resident medical insurance is projected to be CNY 1.118 trillion, with expenditures of CNY 1.066 trillion, resulting in a cumulative balance of CNY 818.3 billion [21]. Group 5: Maternity Insurance - The number of participants in maternity insurance is expected to reach 25.3 million in 2024, with a 30.2% increase in the number of beneficiaries enjoying maternity benefits [32]. - Maternity insurance fund expenditures are projected to be CNY 140.293 billion, reflecting a 19.2% increase from the previous year [32]. Group 6: Medical Assistance - In 2024, medical assistance expenditures are expected to reach CNY 79.232 billion, providing support to approximately 79.16 million people participating in basic medical insurance [34]. - The average assistance for hospitalization and outpatient services is projected to be CNY 1,254 and CNY 92, respectively [34]. Group 7: Drug and Medical Supply Management - The 2024 National Basic Medical Insurance Drug List includes 3,159 drugs, with 91 new additions this year [38]. - The implementation of centralized procurement for drugs and high-value medical consumables continues, with 62 drugs included in the latest round of procurement [43]. Group 8: Cross-Region Medical Services - In 2024, the total number of cross-region medical visits is expected to reach 397 million, with associated costs of CNY 786.774 billion [44]. - Employee medical insurance accounts for 262 million of these visits, while resident medical insurance accounts for 134 million [44].

Core Insights - The report by the International Labour Organization highlights China's significant achievements in expanding universal health coverage, providing valuable experiences for other countries pursuing similar goals [1][2] Group 1: Achievements in Health Coverage - China has established a multi-tiered medical insurance system, expanding coverage from urban workers to rural residents and urban residents, with increasing levels of protection [1] - The basic medical insurance, serious illness insurance, and medical assistance form a three-tiered system to alleviate financial burdens, complemented by commercial health insurance and charitable assistance [1] Group 2: Health Indicators - In 2023, China's average life expectancy increased to 78.6 years, maternal mortality rate decreased to 15.1 per 100,000, and infant mortality rate fell to 4.5 per thousand, placing major health indicators among those of middle to high-income countries [2] Group 3: Challenges Ahead - Despite progress, China's healthcare system faces challenges such as incomplete coverage, quality of insurance, rapid growth in medical costs, and increasing pressure on insurance funds [2] - Future efforts should focus on accurately identifying uninsured individuals, improving insurance quality, establishing a fair and unified benefits system, and developing a stable and sustainable funding mechanism [2]