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服务提质、监管增效……2025上半年德州医保工作亮点纷呈
Qi Lu Wan Bao Wang· 2025-07-24 08:24
Core Viewpoint - The medical insurance system in Dezhou has shown significant progress in the first half of 2025, with various initiatives enhancing the public's sense of security regarding medical insurance [3][4][12]. Group 1: Medical Insurance Fund Performance - In the first half of 2025, the total income of the city's medical insurance fund was 3.886 billion, while total expenditure reached 4.607 billion, resulting in a cumulative balance of 7.352 billion [4]. - The employee medical insurance fund generated an income of 2.349 billion, a year-on-year increase of 6.68%, with expenditures of 1.991 billion, up 3.54% [4]. - The resident medical insurance fund had an income of 1.537 billion and expenditures of 2.616 billion, with a budget execution rate of 54.81% [4]. Group 2: Healthcare Reform and Initiatives - The city has implemented a "Three Medical Linkage + Traditional Chinese Medicine" reform, resulting in savings of 755 million from drug and consumable procurement [5]. - The "Dezhou Huimin Bao" commercial insurance program has seen participation from 334,800 individuals by the end of June [5]. - The city has expanded the number of designated medical institutions for traditional Chinese medicine from 81 to 115 [5]. Group 3: Service Capability Enhancement - The medical insurance settlement process has been optimized, reducing the settlement cycle to 15 working days [6]. - The city aims to cover 5.074 million insured individuals by 2025, with an additional 49,500 new participants this year [6]. - The online processing of medical expense reimbursements reached 12.2045 million cases in the first half of the year [6]. Group 4: Fund Supervision and Management - The city recovered and returned 22.1135 million in medical insurance funds and imposed administrative penalties totaling 3.4545 million in the first half of the year [8]. - A credit and joint supervision system has been established to manage the qualifications of personnel in designated medical institutions [9]. Group 5: Ongoing Reforms and Innovations - The city has implemented reforms in major disease medical insurance and assistance systems, benefiting 110,100 individuals with a total expenditure of 43.0352 million [10]. - The average hospitalization cost has decreased by 6.57% compared to the previous year, with personal hospitalization burdens reduced by 6.84% [10]. - The city has introduced a unified major disease insurance fund, saving 85 million in resident fund expenditures [11]. Group 6: Future Directions - The medical insurance bureau plans to continue deepening reforms and ensuring comprehensive coverage for the population, aiming to enhance the quality of medical insurance services [12].