文 | 赵伟、贾东旭、侯倩楠、耿佩璇 联系人 | 侯倩楠 摘要 人口结构快速变化下，社保制度的完善及改革可能是"十五五"期间重点推进领域之一。当前，我国社保 体系现状如何，面临哪些压力？海外社保制度有何经验？ 本文系统分析，供参考。 一、我国社保改革的历史沿革？我国社保体系正从"广覆盖"迈向高质量发展与全国统筹阶段 我国社会保障制度随经济社会发展需求历经多阶段演进。 1951年《中华人民共和国劳动保险条例》初步 建立城镇职工社保制度；1986年养老保险探索企业与个人共缴的社会统筹，1991年明确国家、企业、个 人三方共担机制，标志从"企业保险"向"社会保险"转型。1998 年起社保体系加速建设，劳动和社会保障 部成立实现行政统一。2010年《社会保险法》推动社保制度进入法治化阶段。 眼下，我国社会保障体系正从"广覆盖"迈向高质量发展与全国统筹阶段。 2014 年，我国整合新农保与城 镇居民养老保险，建立统一的城乡居民基本养老保险制度，逐步打破城乡社保二元分割；2018年，通过 建立企业职工基本养老保险基金中央调剂制度。2022 年第三支柱个人养老金正式实施，形成"基本养老保 险+企业年金和职业年金+个人养老金 ...

国家医保局局长章轲介绍，"十四五"期间，全国基本医保参保率稳定在95%左右。2021年至2024年，累 计近200亿人次享受医保报销。 "居民医保是我送给孩子的第一份礼物！"山东济南刘女士产后住院时，便线上为孩子办好了医保。 来源：新华社 医保，关系着每个人的切身利益，是民生保障中的重要一环。 以解除全体人民的疾病医疗后顾之忧为根本目的，"十四五"以来，我国医保提质扩面广覆盖，进一步减 轻人民群众疾病医疗负担，守好"看病钱""救命钱"。 全民参保进入新阶段 新生儿凭出生证明就可以参保，参保后即可享受待遇；进一步放开放宽参保户籍限制；创新建立参保缴 费激励约束机制……我国全民参保进入新阶段。 ——扩大生育保险覆盖面。截至2025年6月，有2.53亿人参加生育保险，基金累计支出4383亿元，享受 待遇9614.32万人次。 "目前，全国有近六成统筹地区将生育津贴直接发放给参保女职工。"章轲说，我们将加快新生儿护理、 分娩镇痛等价格项目立项，促进儿科、产科优化服务，积极推动目录内生育医疗费用全报销。 ——完善大病保险、医疗救助制度。"十四五"时期各项医保帮扶政策累计惠及农村低收入人口就医达到 6.73亿人次，减轻费 ...

新华社北京8月24日电 医保，关系着每个人的切身利益，是民生保障中的重要一环。 以解除全体人民的疾病医疗后顾之忧为根本目的，"十四五"以来，我国医保提质扩面广覆盖，进一步减 轻人民群众疾病医疗负担，守好"看病钱""救命钱"。 全民参保进入新阶段 国家医保局局长章轲介绍，"十四五"期间，全国基本医保参保率稳定在95%左右。2021年至2024年，累 计近200亿人次享受医保报销。 "居民医保是我送给孩子的第一份礼物！"山东济南刘女士产后住院时，便线上为孩子办好了医保。 新生儿凭出生证明就可以参保，参保后即可享受待遇；进一步放开放宽参保户籍限制；创新建立参保缴 费激励约束机制……我国全民参保进入新阶段。 ——扩大生育保险覆盖面。截至2025年6月，有2.53亿人参加生育保险，基金累计支出4383亿元，享受 待遇9614.32万人次。 "目前，全国有近六成统筹地区将生育津贴直接发放给参保女职工。"章轲说，我们将加快新生儿护理、 分娩镇痛等价格项目立项，促进儿科、产科优化服务，积极推动目录内生育医疗费用全报销。 ——完善大病保险、医疗救助制度。"十四五"时期各项医保帮扶政策累计惠及农村低收入人口就医达到 6.73亿人 ...

新华社北京8月24日电 题：织密医疗保障网——我国基本医保制度不断完善 新华社记者彭韵佳、徐鹏航 医保，关系着每个人的切身利益，是民生保障中的重要一环。 以解除全体人民的疾病医疗后顾之忧为根本目的，"十四五"以来，我国医保提质扩面广覆盖，进一步减 轻人民群众疾病医疗负担，守好"看病钱""救命钱"。 全民参保进入新阶段 国家医保局局长章轲介绍，"十四五"期间，全国基本医保参保率稳定在95%左右。2021年至2024年，累 计近200亿人次享受医保报销。 "居民医保是我送给孩子的第一份礼物！"山东济南刘女士产后住院时，便线上为孩子办好了医保。 新生儿凭出生证明就可以参保，参保后即可享受待遇；进一步放开放宽参保户籍限制；创新建立参保缴 费激励约束机制……我国全民参保进入新阶段。 ——扩大生育保险覆盖面。截至2025年6月，有2.53亿人参加生育保险，基金累计支出4383亿元，享受 待遇9614.32万人次。 "目前，全国有近六成统筹地区将生育津贴直接发放给参保女职工。"章轲说，我们将加快新生儿护理、 分娩镇痛等价格项目立项，促进儿科、产科优化服务，积极推动目录内生育医疗费用全报销。 ——完善大病保险、医疗救助制度。 ...

全民参保进入新阶段 国家医保局局长章轲介绍，"十四五"期间，全国基本医保参保率稳定在95%左右。2021年至2024年，累 计近200亿人次享受医保报销。 "居民医保是我送给孩子的第一份礼物！"山东济南刘女士产后住院时，便线上为孩子办好了医保。 新生儿凭出生证明就可以参保，参保后即可享受待遇；进一步放开放宽参保户籍限制；创新建立参保缴 费激励约束机制……我国全民参保进入新阶段。 ——扩大生育保险覆盖面。截至2025年6月，有2.53亿人参加生育保险，基金累计支出4383亿元，享受 待遇9614.32万人次。 "目前，全国有近六成统筹地区将生育津贴直接发放给参保女职工。"章轲说，我们将加快新生儿护理、 分娩镇痛等价格项目立项，促进儿科、产科优化服务，积极推动目录内生育医疗费用全报销。 新华社北京8月24日电 题：织密医疗保障网——我国基本医保制度不断完善 新华社记者彭韵佳、徐鹏航 医保，关系着每个人的切身利益，是民生保障中的重要一环。 以解除全体人民的疾病医疗后顾之忧为根本目的，"十四五"以来，我国医保提质扩面广覆盖，进一步减 轻人民群众疾病医疗负担，守好"看病钱""救命钱"。 跨省共济，只是医保待遇保障"扩容 ...

Group 1: Medical Insurance Development - The National Medical Security Administration emphasizes empowering the pharmaceutical industry and implementing measures to support high-quality development of innovative drugs [1][2] - By mid-2025, significant progress is expected in medical security, including an increase in the number of people covered by maternity insurance to 253 million and maternity insurance benefit expenditures reaching 67.832 billion yuan in the first half of the year [1] - The meeting highlights the need for a comprehensive adjustment of the national medical insurance drug catalog and the establishment of a commercial health insurance innovative drug catalog [2] Group 2: Maternity Insurance and Long-term Care - The meeting encourages regions to include flexible employment workers, migrant workers, and new employment forms in maternity insurance coverage, while also exploring basic service packages for prenatal check-ups [3] - Long-term care insurance will be fully implemented, with a focus on planning and configuring designated long-term care service institutions and encouraging commercial insurance products that align with long-term care services [3] Group 3: Digital Transformation in Medical Insurance - The meeting calls for a shift in medical insurance from passive payment to active empowerment, focusing on health investment rather than disease compensation [3] - There is an emphasis on integrating medical insurance with technology to promote new medical services, AI health management, and smart elderly care [3]

Core Viewpoint - The recent judicial interpretation by the Supreme Court invalidates any agreements between employers and employees regarding the non-payment of social insurance fees, emphasizing that social insurance is a legal obligation akin to taxation [1][3][4]. Summary by Sections Legal Implications - Any agreement to avoid social insurance payments, whether initiated by employers or employees, will be deemed invalid after September 1, 2023, significantly increasing the cost of avoiding social insurance for employers [3][4]. - The Supreme Court's stance highlights the legal necessity of social insurance, reinforcing its mandatory nature for both employers and employees [4]. Current Social Insurance Landscape - As of 2024, China has approximately 734 million employed individuals, but only about 246 million, or 33.5%, are fully covered by social insurance [4]. - The social insurance system in China, which includes five types of insurance and housing fund, has been historically mandatory since its inception [5][6]. Financial Aspects - The minimum social insurance contribution in Beijing for 2024 totals approximately 2,524 yuan per month, with individuals contributing around 716 yuan if they are self-employed [6]. - The 2024 national social insurance fund budget anticipates revenues of 11.89 trillion yuan, a 5.2% increase, against expenditures of 10.61 trillion yuan, indicating a surplus of 1.29 trillion yuan [10]. Demographic Challenges - China is facing a demographic shift with a significant increase in retirees, projected to exceed 20 million annually, while the potential labor supply is only about 17-18 million per year [13][14]. - The imbalance between the growing retired population and the working-age population poses a long-term challenge for the social insurance system [14]. Government Measures - The government is exploring various strategies to address the funding gap in the social insurance system, including increasing fiscal subsidies and reallocating funds from wealthier provinces to support less affluent regions [15][16]. - There is a focus on enhancing compliance with social insurance payments among employers, which may lead to increased operational costs for businesses, particularly in low-margin sectors [17][18]. Future Considerations - The current social insurance system may require further improvements to enhance its attractiveness and coverage, especially for younger, mobile workers [20][21]. - The necessity of social insurance is framed not only as a legal obligation but also as a long-term investment for individuals, with potential benefits in times of need [21].

Core Insights - The National Medical Insurance Administration is focusing on expanding the coverage of maternity insurance, aiming to include employees of enterprises and those receiving unemployment benefits [1] - By June 2025, the number of people covered by maternity insurance is projected to reach 253 million [1] Group 1 - The Deputy Director of the Benefits Security Department, Liu Juan, emphasized the importance of ensuring that eligible employees and unemployment benefit recipients participate in maternity insurance [1] - There is a continuous effort to guide local authorities to include flexible employment workers, migrant workers, and new employment form personnel in the maternity insurance coverage [1]

Core Viewpoint - The National Medical Insurance Administration emphasizes the importance of enhancing the quality of medical insurance services during the "14th Five-Year Plan" period, focusing on improving access and affordability for the public [1][3]. Group 1: Medical Insurance Coverage and Expenditure - The national basic medical insurance coverage rate has remained stable at around 95%, with a cumulative expenditure of 12.13 trillion yuan, averaging an annual growth rate of 9.1% [1]. - By 2024, the number of people covered by basic medical insurance is expected to reach 1.327 billion [1]. - Nearly 200 billion medical insurance reimbursements have been enjoyed by approximately 200 million people from 2021 to 2024 [1]. Group 2: Support for Specific Demographics - Measures have been taken to enhance support for the elderly and children, including the establishment of a long-term care insurance system, with 190 million participants by the end of 2024 [2]. - The cumulative expenditure for maternity insurance has reached 438.3 billion yuan, benefiting over 96 million people [2]. Group 3: Reducing Medical Costs - Policies have reduced the financial burden on rural low-income populations by over 650 billion yuan during the "14th Five-Year Plan" [3]. - The long-term care insurance has benefited over 2 million disabled individuals, reducing care service costs by over 50 billion yuan [3]. - Direct settlement for cross-provincial medical treatment has reduced the need for out-of-pocket expenses by 590 billion yuan [3]. Group 4: Technological Advancements in Medical Insurance - A unified national medical insurance information platform has been established, significantly improving management efficiency [4]. - The number of people using medical insurance codes has exceeded 1.236 billion, facilitating direct payment for medical services [4]. - The number of direct settlements for cross-provincial medical treatment has increased from 5.37 million in 2020 to 23.8 million in 2024, a 44-fold increase [4]. Group 5: Fund Management and Security - By the end of 2024, the cumulative balance of the medical insurance fund is expected to reach 3.86 trillion yuan [5]. - The administration has recovered 104.5 billion yuan through enhanced fund management and monitoring [5]. - Innovative regulatory measures have been implemented to combat fraud, including the use of big data analysis to identify irregularities [6]. Group 6: Support for Innovative Drugs - Expenditure on innovative drugs has increased significantly, with spending in 2024 being 3.9 times that of 2020, reflecting an annual growth rate of 40% [8]. - A total of 402 new drugs have been added to the medical insurance catalog since the beginning of the "14th Five-Year Plan" [8]. - The establishment of a commercial health insurance catalog for innovative drugs has seen over 100 drugs submitted for approval [9]. Group 7: Future Directions - The National Medical Insurance Administration aims to continue managing the medical insurance fund effectively while supporting the development of the pharmaceutical industry [9]. - The focus will be on providing efficient, safe, and accessible medical products and services to the public, contributing to the overall health of the nation [9].

Core Insights - The healthcare insurance system in China is set to cover nearly 20 billion medical reimbursements from 2021 to 2024, with 2024 figures projected to be 1.6 times that of 2020 [1] - The system aims to enhance quality and expand coverage, focusing on vulnerable groups including the elderly and children, while providing targeted support for low-income populations [1][11] Group 1: Childcare and Maternal Health - The healthcare insurance system is strengthening maternity insurance, with 253 million participants and cumulative expenditures of 438.3 billion yuan, benefiting 96.14 million people by June 2025 [3] - Newborns can now enroll in basic health insurance using their birth certificates, and nearly 60% of regions provide direct maternity benefits to female employees [3] Group 2: Elderly Care - A long-term care insurance system is being established, with 190 million participants expected by the end of 2024, addressing the needs of disabled individuals requiring long-term care [5] Group 3: General Health Coverage - The employee health insurance system has expanded its outpatient mutual aid mechanism, allowing personal accounts to cover near relatives, with over half of the regions implementing this nationwide [7] Group 4: Chronic Disease Management - Ten types of outpatient chronic diseases can now be reimbursed directly across provinces, benefiting 560 million people and reducing out-of-pocket expenses by 590 billion yuan [9] - The dynamic adjustment of the healthcare drug list has led to the inclusion of 402 new drugs since the start of the 14th Five-Year Plan [9] Group 5: Support for Low-Income Populations - The healthcare insurance policies have benefited 673 million low-income individuals in rural areas, alleviating over 650 billion yuan in medical expenses [11]