2025.12. 31 本文字数：2208，阅读时长大约4分钟 基本医保省级统筹可以扩大医保基金共济范围、提高医保基金抵御风险能力，同时也是提升医保基金 治理水平的举措。 从1994年职工医保改革的"两江试点"（江西九江、江苏镇江）算起，长期以来，中国的医保是以县 级统筹为主，医保基金的资金池建立在县里，这导致各地在筹资水平、待遇标准、支付方式和预算管 理等各不相同，医保制度出现严重碎片化。 "十四五"期间，我国基本实现了医保基金的市级统筹，"十五五"努力推进省级统筹。 从地方实施的省级统筹模式看，主要是两种：一是统收统支的模式，即全省（市）医保基金统一征 收、管理和支出，北京、上海、天津、重庆、海南等省（市）实现了统收统支，这些省份的特点是内 部差异较小，其中4个是直辖市。此外，还有青海在居民医保实现省级统收统支的基础上，将在2026 年1月1日实施职工医保省级统筹，设置3年过渡期，过渡期后适时实行基金省级统收统支。 另一种是更加主流的省级调剂金模式，通常设立基础调剂金和紧急调剂金。基础调剂金用于事前均衡 各地因老龄化、人口结构等因素造成的基金压力；紧急调剂金用于事后弥补基金当期缺口，应对重大 疫情等突发风 ...

Market Overview - The market experienced fluctuations in the afternoon, with mixed performance across the three major indices. The Shanghai Composite Index slightly increased, achieving a nine-day winning streak, while the ChiNext Index saw a decline of over 1% at one point. The total trading volume in the Shanghai and Shenzhen markets was 2.14 trillion, a decrease of 20.9 billion from the previous trading day. Overall, more stocks declined than rose, with over 3,300 stocks falling [2]. Sector Performance - The humanoid robot sector saw significant gains, with companies like Boke Technology hitting the daily limit of a 20% increase, marking a historical high. The Ministry of Industry and Information Technology recently held a meeting to establish standards for humanoid robots and embodied intelligence, which is expected to drive further growth in this sector [4]. - The digital currency sector also performed well, with Lakala rising nearly 12% and other companies like Cuiwei Co. and Sifang Jingchuang seeing gains. This follows the People's Bank of China revising rules for the cross-border payment system to support the development of cross-border RMB business [5]. Real Estate Policy Impact - Following adjustments to real estate policies in Beijing, the average daily transaction volume of new residential properties increased by 44.6% compared to the period before the policy change. The new policy is expected to have a ripple effect on other cities like Shanghai and Shenzhen, although market differentiation remains evident, particularly in non-core areas [6][7]. Healthcare Sector - The basic medical insurance fund's total income for the first eleven months of 2025 reached 2.632 trillion, with total expenditures of 2.110 trillion. The fund's operation remains stable, with contributions from both employee and resident insurance systems [8]. Investment Insights - Guojin Securities highlighted that a new investment theme is emerging in the commodity market, with a focus on industrial resources like copper, aluminum, tin, lithium, and crude oil. The report suggests that the recovery of global manufacturing and the rebound in domestic consumption will create opportunities in sectors such as aviation, hotels, and non-bank financial services [9][10].

义乌与全球230多个国家和地区保持贸易往来，目前在义乌的外商达3万余人，年接待入境外籍人员超60 万人次。依托国贸综合改革试点释放的红利，义乌持续深化涉外医保改革，除灵活就业人员参保政策 外，还允许取得义乌市中小学学籍的外籍儿童参加基本医疗保险及大病保险，全方位覆盖外籍人员医保 需求。 （来源：工人日报） 12月17日上午，俄罗斯客商索菲亚在浙江省义乌市国际贸易服务中心顺利完成职工基本医疗保险参保登 记，成为该市第1万名参保外籍人员。这标志着义乌正式成为全国首个外籍人员医保参保破万人的县级 市。 本报通讯员 钱旭升 摄 ...

今年的全国医疗保障工作会议提出，深入推进医保改革，积极推进科技创新，助力医疗事业和医药产业 发展，持续为人民健康、经济社会发展和科技进步注入医保新动能，努力实现"十五五"时期医保事业良 好开局。 从异地就医刷卡直接结算、医保钱包跨省共济，到创新药更快进医保、更多质优价宜的集采药品进基 层，再到生育保险让生娃少花钱、长期护理保险试点覆盖3亿人，"十四五"期间，医保改革的制度红利 持续释放，为我国的民生保障与医药产业升级注入确定性。 当前，我国医保制度面临的最大挑战是在人口老龄化趋势下医保基金收支平衡的压力，尤其是一些老年 抚养比高的地区抵御风险能力较为脆弱，急需通过提高统筹层次来发挥保险互助共济优势。同时，科技 和社会进步也为医保制度带来了一系列新挑战，以传统单位劳动关系为基础的职工医保需要适应新就业 形态的变化。 "十四五"期间，医保制度的另一个新变化是全民参保结构逐步优化，职工医保人数占总参保人数比重逐 年增加。今年的中央经济工作会议提出，鼓励支持灵活就业人员、新就业形态人员参加职工保险，将更 多的劳动者纳入职工医保这一更加稳健的社保体系也是全民医保下一步的方向。 截至2024年底，全国基本医疗保险（下称" ...

国家医保局数据显示，5年来，医保基金运行总体平稳，基金收支平衡，基本医保参保率稳定在95%，基金总支出超过13万亿 元；医保制度不断完善，职工医保、居民医保政策范围内住院费用报销比例分别稳定在80%和70%左右。 截至2024年底，全国基本医疗保险（下称"基本医保"）参保132662.08万人，2024年基本医保（含生育保险）基金总收入 34913.37亿元，基金总支出29764.03亿元；统筹基金当期结存4639.17亿元，累计结存38628.52亿元。 从年度基金结余数据可知，我国医疗保障资金基本盘稳健，2023年~2024年，国家医保局公布的累计结余数据为统筹基金累计结 余，不含职工基本医保个人账户，分别为3.4万亿元、3.9万亿元。若加上个人账户资金结余，总的累计结余为4.3万亿、4.8万 亿，五年来保持稳定增长。 医保省级统筹涉及关键的利益调整。 从异地就医刷卡直接结算、医保钱包跨省共济，到创新药更快进医保、更多质优价宜的集采药品进基层，再到生育保险让生娃 少花钱、长期护理保险试点覆盖3亿人，"十四五"期间，医保改革的制度红利持续释放，为我国的民生保障与医药产业升级注入 确定性。 当前，我国医保制度 ...

政策规定，"零自付"并不代表完全不用花钱，医保目录范围外的一些自费药品、耗材或医疗服务项目，如单人间、套间病房， 床位费支付标准以上部分等，属于个人自费费用，不属于补助范围。 而且，"零自付"生娃待遇为免申即享，即无论是江苏职工医保，还是居民医保，只要处于待遇享受期，在定点医疗机构住院分 娩的，市民无需申请，出院结算时即可享受财政补助。异地生育的孕产妇，也可以享受同样待遇。 有宝妈晒出生娃个人只花了9元的账单。 近日全国医保工作会议提出，明年力争实现全国生娃基本不花钱。 生娃不花钱政策如何落地？对于宝妈来说，哪些费用属于"基本"不花钱的范围，哪些又处于"不基本"需要自付的范围？ 16日，国家医保局以"医保支持生育"为主题连发五篇文章推荐地方生娃基本不花钱的经验，用地方实践和真实的医保数据回应 了大家关心的这些问题。 全国医保工作会议提出，推动将灵活就业人员、农民工、新就业形态人员纳入生育保险覆盖范围。合理提升产前检查医疗费用 保障水平，力争全国基本实现政策范围内分娩个人"无自付"。 国家医保局数据显示，到2025年底，31个省（区、市）及新疆生产建设兵团均已将符合条件的辅助生殖项目纳入医保，7个省份 实现政策 ...

Core Points - The State Council has emphasized the importance of advancing provincial-level coordination of basic medical insurance as a significant measure to improve the universal medical insurance system [1] - This initiative aims to enhance the mutual assistance advantages of insurance and strengthen the保障能力 of the medical insurance system [1] Summary by Categories - **Policy Implementation** - The meeting calls for tailored strategies by local governments to determine appropriate fund management models for provincial-level coordination [1] - It emphasizes the need to improve fund utilization efficiency [1] - **Healthcare Resource Management** - The coordination of basic medical insurance and the establishment of a hierarchical medical service system are to be promoted [1] - There is a focus on accelerating the balanced distribution of high-quality medical resources [1] - **Service Improvement** - Strengthening the capacity of grassroots medical services is highlighted as a priority [1] - The need to refine medical insurance payment and service pricing adjustment mechanisms is also noted to better meet the healthcare needs of the public [1]

Core Insights - The article highlights the ongoing efforts in Zhenjiang to enhance the multi-tiered medical insurance system, with a focus on increasing public awareness and participation in health insurance programs [1][2] Group 1: Insurance Participation and Financials - As of September 2023, Zhenjiang has achieved a basic medical insurance enrollment of 2.77 million people, with total insurance fund income of 6.459 billion yuan and total expenditure of 6 billion yuan from January to September, indicating a stable and sustainable fund operation [1] - A personal story shared during the event illustrates the financial relief provided by the insurance system, where a resident's father underwent surgery costing 53,000 yuan, with the insurance fund covering 37,000 yuan [1] Group 2: Public Awareness Campaigns - The city is conducting a month-long promotional campaign themed "China's Medical Insurance, Lifelong Protection," involving multiple departments to target various demographics including newborns, students, flexible workers, and the elderly [2] - The campaign includes community outreach, policy explanations, and distribution of promotional materials to foster a better understanding of medical insurance policies and encourage enrollment [2] - The city aims to provide personalized services and communication strategies to ensure that insurance policies are effectively conveyed to the public, thereby promoting universal participation in health insurance [2]

Core Viewpoint - The continuous efforts in expanding and improving social security in China have resulted in basic pension and medical insurance coverage rates remaining above 95%, ensuring the basic needs of the population are met [1] Group 1 - The Deputy Director of the National Bureau of Statistics emphasized the importance of social security in safeguarding the basic needs of the people [1] - The participation rates for basic pension and medical insurance have consistently been maintained at over 95% [1]

Core Points - DSW, a Dutch health insurance company, announced that its basic health insurance premiums will remain unchanged in 2026, breaking the trend of annual increases seen in recent years [1][3] - The monthly premium will continue to be €158.50, and the mandatory deductible will also stay the same [3] - The stability in premiums is attributed to a surplus in the Health Insurance Fund, which had an income exceeding expenses by €2.4 billion last year [3][6] Group 1 - DSW's decision is often seen as a benchmark for other health insurance companies in the Netherlands [1] - The surplus from the Health Insurance Fund must be used by health insurers to limit premium increases [3] - Without the fund's support, DSW indicated that premiums would have increased by €6 [3] Group 2 - There is a warning that premiums may rise again in 2027 due to ongoing increases in healthcare costs [5][6] - Since 2016, health insurance premiums in the Netherlands have risen by 53%, outpacing the inflation rate of 33% during the same period [6] - Other health insurance companies are expected to announce their 2026 premiums in the coming weeks, with deadlines for notifying customers set for November [6]