聚焦"一老一小"群体，力促"直达快享"。系统性整合高血压、糖尿病等门诊慢特病病种至26种，实施分 级分类保障，年惠及老年患者超60万人次。全面推进长期护理保险制度，建制后将进一步减轻重度失能 人员家庭照护负担；在促进生育保障方面，将取卵术、胚胎培养等9项辅助生殖技术纳入医保支付范 围，报销比例达50%，每年为2000多个家庭减轻生育费用负担500余万元。生育津贴发放由"企业中 转"变为"个人直享"。"十四五"期间，生育保险累计为39.28万人次参保职工支付待遇17.97亿元。居民生 育医疗费用纳入基本医保报销范围，政策范围内住院分娩费用医保基金支付比例达70%以上。 强化资助参保，兜牢"保障底线"。将特困人员、低保对象、返贫致贫人口等精准标识于医保平台，并进 行动态更新，确保不重不漏。对特困人员进行全额资助，个人"零缴费"。对低保对象等实行定额资助， 大幅减轻个人负担。"十四五"期间，累计资助参保农村低收入人口达247.27万人次，支出参保资助资金 5.7亿元。 完善三重制度，化解"就医之忧"。提高财政补助与个人筹资标准，提升门诊统筹支付额度与基本医保待 遇。统一城乡居民大病保险起付标准，对困难群众实施"一降 ...

从织密全球最大医保网络，到破解失能人群照护难题；从优化生育保障链条，到加速新药好药普惠可及；从深化支付方式改革，到筑牢基金监 管防线，"十四五"时期，我国医保基金稳健运行，夯实保障根基；集采改革持续深化，药品价格合理回归；服务网络不断下沉，"家门口"便捷 医保服务越走越近…… 这张更加公平、更加持续、更有效率的全民医保网，筑就更加坚实的"健康中国"底盘。跟随海报，共同感受大国医保如何撑起全民健康守护 伞，让"病有所医"化作亿万群众触手可及的获得感、幸福感与安全感。 "十四五"期间，全国基本医保参保率稳定在95%左右 � · 2024年度全国基本医保参保人数达到13.27亿人 ● 职工和居民住院费用目录内基金支付比例 稳定在80%和70%左右 · 截至2024年底，医保统筹基金累计结余3.86万亿元 新华丽 最大期期 il · 出台失能等级评估、服务机构管理、长期照护师等15个文件 · 长期护理保险定点服务机构超过了8800家 新华社 ST BERE NT 177 11:14 护理服务人员达到30万人 · 长期护理保险制度试点深入推进，参保覆盖达1.9亿人 · "十四五"期间累计惠及超过200万失能群众 减轻群 ...

新华社北京12月3日电 题：健全多层次医疗保障体系 筑牢民生保障底线——访国家医保局局长章 轲 新华社记者彭韵佳 医保，关系每个参保人的切身利益。党的二十届四中全会审议通过的《中共中央关于制定国民经济 和社会发展第十五个五年规划的建议》（以下简称《建议》），提出"健全多层次医疗保障体系""推进 基本医疗保险省级统筹"等系列部署。 如何健全多层次医疗保障体系？如何让医保改革成果更好惠及群众健康？新华社记者专访了国家医 保局局长章轲。 破解看病难、看病贵问题取得突破性进展 问："十四五"时期，医疗保障制度改革如何提升百姓获得感？ 答：党的十八大以来，全民医疗保障制度改革持续推进，参保质量明显提升，人民群众医保获得感 显著提高。 国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重基本 医疗保障制度进一步巩固提升。职工医保、居民医保政策范围内住院费用报销比例分别达到80%和70% 左右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。大病保 险进一步减负，城乡居民大病保险保障水平在基本医保基础上提高10到15个百分点。健全统一规范的医 疗救助制度。 ...

原标题：贯彻落实党的二十届四中全会精神权威访谈|健全多层次医疗保障体系 筑牢民生保障底线—— 访国家医保局局长章轲 新华社北京12月3日电（新华社记者 彭韵佳）医保，关系每个参保人的切身利益。党的二十届四中全会 审议通过的《中共中央关于制定国民经济和社会发展第十五个五年规划的建议》（以下简称《建 议》），提出"健全多层次医疗保障体系""推进基本医疗保险省级统筹"等系列部署。 如何健全多层次医疗保障体系？如何让医保改革成果更好惠及群众健康？新华社记者专访了国家医保局 局长章轲。 破解看病难、看病贵问题取得突破性进展 国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重基本医疗 保障制度进一步巩固提升。职工医保、居民医保政策范围内住院费用报销比例分别达到80%和70%左 右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。大病保险 进一步减负，城乡居民大病保险保障水平在基本医保基础上提高10到15个百分点。健全统一规范的医疗 救助制度。 以"减负、提质、便民"为导向，多举措强化保障实效。"十四五"期间，医保基金累计支出超13万亿元， 惠及近200亿 ...

Core Viewpoint - The controversy surrounding the "15-day hospitalization limit for insurance reimbursement" highlights the deep-rooted issues within China's healthcare insurance system, reflecting the struggles faced by patients, hospitals, and insurance providers amid increasing financial pressures [1][10]. Summary by Relevant Sections Healthcare Insurance System - The rapid aging of the population and rising healthcare demands are leading to a continuous increase in the expenditure pressure on healthcare insurance funds, with total income projected at approximately 3.2 trillion yuan in 2024, while expenditure growth outpaces income growth [1][10]. Hospital Operations - Hospitals, particularly public ones, face significant operational challenges as insurance payment standards often do not cover actual treatment costs, especially for complex and long-term patients. This leads to potential financial losses if hospitals have to cover excess costs themselves [4][10]. Patient Experience - Patients experience severe disruptions in treatment continuity due to frequent transfers or forced discharges, which can negatively impact recovery and increase out-of-pocket expenses. The bureaucratic process of repeated admissions adds to their stress and fatigue [6][10]. Policy and Management - The current "one-size-fits-all" approach to cost control lacks flexibility, particularly for special cases like cancer and severe rehabilitation, necessitating a more nuanced management strategy that avoids rigid limitations on hospitalization [6][10]. Recommendations for Improvement - Suggestions include optimizing payment methods such as promoting DRG/DIP payment models, enhancing regulatory oversight to prevent malpractice, developing a tiered healthcare system to alleviate pressure on major hospitals, and encouraging diversified healthcare insurance options to share the burden of basic insurance [7][9][10].

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 collaboration between basic medical insurance and commercial health insurance in China is advancing significantly, with new measures and systems being implemented to enhance efficiency and accessibility for patients [1][2][3][4]. Group 1: Policy Developments - The first national "medical insurance + commercial insurance" clearing settlement center has begun operations in Beijing, reducing the time lag in claims settlement between the two systems [1]. - A joint initiative by the Shanghai Financial Regulatory Bureau and seven other departments has been launched to promote the high-quality development of commercial health insurance, focusing on payment mechanisms and data sharing [1][2]. - The preliminary review of the innovative drug directory for commercial insurance, which includes several high-priced cancer drugs, has been completed, providing new payment avenues for innovative drugs [1][2]. Group 2: Market Insights - As of 2024, the basic medical insurance system covers 1.326 billion people, maintaining a coverage rate of 95%, with total fund expenditures reaching 2.97 trillion yuan [2]. - The commercial health insurance market is experiencing rapid growth, with original insurance premium income reaching 977.3 billion yuan in 2024, a year-on-year increase of 8.2% [2]. - Despite the growth, there remains significant room for improvement in the coverage and effectiveness of commercial health insurance compared to the over 95% utilization rate of basic medical insurance funds [2]. Group 3: Operational Enhancements - The new clearing settlement center allows patients to complete basic insurance reimbursement and directly use commercial insurance for remaining costs, streamlining the payment process [2][3]. - The National Medical Insurance Administration is exploring synchronized settlement between basic and commercial health insurance, aiming to reduce patient burden through data sharing [3]. - Future developments will include collaborative efforts to expand the coverage of commercial health insurance and enhance the integration of data and regulatory frameworks between the two systems [4].

Group 1 - The core viewpoint of the news is the stable operation of the basic medical insurance fund in Hainan province, with a total income of 8.263 billion yuan and total expenditure of 6.451 billion yuan from January to May this year, resulting in a cumulative balance of 45.929 billion yuan [1] - As of June 13, the total number of insured individuals in the province reached 9.5237 million, with a comprehensive insurance rate stabilizing around 95% [1] - The province has eliminated the household registration restrictions for insurance participation and improved the incentive and constraint mechanisms for continuous insurance, focusing on specific groups such as college students and new employment forms [1] Group 2 - The province has increased the ordinary outpatient benefits for employee medical insurance, raising the annual maximum payment limit to 25,000 yuan for employed individuals and 30,000 yuan for retirees [1] - The "Hui Qiong Bao" 2025 version of the one-stop claim service has been launched, allowing simultaneous settlement of medical insurance, commercial insurance, and out-of-pocket expenses, eliminating the need for upfront payments by insured individuals [2] - The cross-provincial direct settlement for medical treatment has been actively promoted, with 366 hospitals and 744 outpatient facilities already connected for direct settlement [2]