Create a new situation of high -quality development of national medical insurance during the "Fourteenth Five -Year Plan" period

Author:China Medical Insurance Time:2022.06.17

2021 is the beginning of the "Fourteenth Five -Year Plan" period. Recently, the National Medical Insurance Administration issued the "Statistics of the National Medical Security Development Statistics of 2021", which fully reflects the in -depth implementation of the national medical insurance system to implement the decision -making and deployment of the Party Central Committee and the State Council. "Planning" and the development goals and work tasks determined by the National Medical Security Work Conference in 2021, comprehensively deepen the reforms in the field of medical security, strive to promote the high -quality development of medical security undertakings, achieve remarkable achievements, and create the "14th Five -Year Plan" period. The new situation of reform and development in the field of medical security has written a new chapter in the booming development of China's medical security.

1. The number of participants has increased steadily, and medical insurance for the whole people continues to be consolidated

As of the end of 2021, the number of basic medical insurance participants in the country was 1.363 billion, which was slightly increased from the previous year, and the participation rate continued to stabilize more than 95%. Among them, the number of employees' medical insurance insured was 354 million, an increase of 9.76 million over the previous year, an increase of 2.8%. Among them, 261 million in -service employees, an increase of 2.7%over the previous year. Among them, the number of other personnel such as enterprises, agencies, and flexible employment increased by 7.26 million, 1.48 million, and 1.01 million respectively over the previous year. At the same time, the basic medical insurance insurance for urban and rural residents was 1.09 billion, a decrease of 8.1 million from the previous year, a decrease of 0.8%, and the decline was the same as the previous year. In the past three years, residents' medical insurance and employee medical insurance continued to show their long trends in terms of the number of insureds, which is conducive to the steady development of medical insurance for national medical insurance.

2. The status of the medical insurance fund's income and expenditure has improved significantly, and the anti -risk strength has increased significantly

With the effective control of the new coronary pneumonia's epidemic in 2021, most industries gradually returned to normal, and the income and expenditure status of medical insurance funds in various places improved accordingly. Judging from the revenue and expenditure of the National Basic Medical Insurance Fund (including maternity insurance) in 2021, the main indicators have shown a significant growth trend. According to statistics, in 2021, the total revenue of basic medical insurance (including maternity insurance) funds nationwide was 2.87 trillion yuan, an increase of 15.6%over the previous year; the total expenditure of basic medical insurance (including maternity insurance) funds was 2.40 trillion yuan, an increase of the previous year, which was over the previous year. 14.3%; basic medical insurance (including maternity insurance) funds increased to 3.62 trillion yuan. Among them, the cumulative deposit (including maternity insurance) of employee medical insurance overall funds (including maternity insurance) reached 1.77 trillion yuan, an increase of 15.39%over the previous year, and the number of months of payment was 22.8 months. And the pressure of fund revenue and expenditure is constantly increasing.

Third, the number of medical insurance treatment and the number of average hospitalization costs continued to increase

In 2021, with the gradual improvement of the epidemic prevention and control situation, the condition of the insured persons basically returned to normal and enjoyed the corresponding medical insurance treatment. Among them, the number of people participating in employees' medical insurance staff enjoyed 2.040 billion, an increase of 13.9%over the previous year. Among them, the number of inpatients was 0.59 billion, an increase of 11.8%over the previous year; the average hospital hospitalization fee was 12948 yuan, an increase of 2.3%over the previous year, which remained basically stable. Participating in residents' medical insurance staff enjoyed 2.081 billion, an increase of 4.7%over the previous year. Among them, the number of inpatients was 153 million, which was basically the same as the previous year; the average hospital hospitalization fee was 8023 yuan, an increase of 6.3%over the previous year, a larger increase.

Fourth, medical assistance provides a strong guarantee for low -income groups and medical treatment

Medical assistance is an important part of the multi -level medical security system. It plays an important role in preventing low -income people from poverty and returning to poverty due to illness. The state attaches great importance to medical assistance and continues to increase financial investment in medical assistance. In 2021, the expenditure of medical assistance was 61.990 billion yuan, of which the central government arranged medical assistance subsidy funds of 30.2 billion yuan, an increase of 16.2%over the previous year. By funding 88.16 million people in low -income groups participated in basic medical insurance to ensure that the participation rate of low -income population in rural areas is stable at more than 99%. The outpatient and hospitalization assistance exceeded 100 million people, reducing the burden of medical expenses of low -income population in the countryside of 122.41 billion yuan, of which 1074 yuan was rescued, which effectively reduced the burden of medical treatment of low -income groups.

5. Continue to carry out the medical insurance and drug directory access negotiations, and continue to improve the medical insurance and drug catalog

In 2021, the National Medical Insurance Bureau further improved the drug evaluation index system, continued to organize the medical insurance drug directory access negotiation, and issued the "Catalog of National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drugs (2021)". Through the National Medical Insurance Catalog Admission negotiation and selection of experts, 74 new drugs are included in the medical insurance catalog, including the shortcomings of chronic diseases, rare diseases and anti -tumor drugs, so that the drugs in the new version of the medical insurance drug catalog in 2021 The total number increased to 2860. By carrying out the national medical insurance drug directory access negotiations, 67 drugs decreased by 62%. By establishing a "dual -channel" guarantee mechanism for the establishment of a state -conversion medicine, it is ensured that the national conversible drugs can successfully enter the hospital or pharmacy to meet the needs of the majority of patients. In 2021, the price reduction and medical insurance reimbursement benefited 400 million patients, of which 140 million people enjoyed the medical insurance reimbursement involving 221 types of national talks, reducing the medical burden of the majority of patients by 149.49 billion yuan, allowing ordinary people to fully enjoy the medical insurance and drug catalog standards. The benefits brought by negotiations, price reductions and reimbursement. 6. Deepen the reform of medical insurance payment has achieved remarkable results

According to the deployment and requirements of the National Medical Insurance Bureau on deepening the reform of medical insurance payment methods, the key tasks of the reform of medical insurance payment methods in 2021 are to promote DRG and DIP pilot work according to local conditions, and ensure that DRG and DIP countries are transferred to the actual payment stage. In November 2021, the National Medical Insurance Administration formulated and issued the "Notice of the National Medical Security Bureau on the three -year action plan for the reform and distribution of DRG/DIP payment methods", and proposed to accelerate the establishment of a efficient medical insurance payment mechanism to promote the high -quality development of medical insurance. Under the organization and guidance of the State Medical Insurance Bureau, in 2021, the national pilot cities and 71 regional points of the country's pilot cities and 71 regional points method budget budgets and pilot cities of the 71 regional points (DRG) are paid. The paid stage and determined the DRG/DIP demonstration point city. Zhejiang, Guangxi and other places have also promoted the reform of the DRG payment method throughout the province. By vigorously promoting the reform of DRG and DIP payment, it has achieved significant results in regulating the diagnosis and treatment behavior of hospitals, excessive growth of medical expenses, and promoting the balance of revenue and expenditure of medical insurance funds.

7. Give full play to the strategic purchase of medical insurance in pharmaceutical procurement

The national organizational drug concentrated volume procurement is an effective measure to give full play to the strategic purchase of medical insurance. In 2021, the National Medical Insurance Bureau made the work deployment of the "Opinions of the General Office of the State Council on the normalization and institutionalization of pushing for the normally and institutionalization of drugs in the presence of drugs". The procurement system for the level of the platform has gradually realized the drugs and medical consumables required for public medical institutions from the provincial platform. In 2021, the total amount of orders through the provincial -level drug centralized procurement platform exceeded the 1 trillion mark, reaching 1.03 trillion yuan, an increase of 11.04%over the previous year. The drugs in the medical insurance directory were 825.9 billion yuan, accounting for 79.9%of the total amount of online mining orders. Three batches of national organizational drugs were carried out throughout the year, involving 122 varieties, with an average price reduction of 52%. The results of the first five batches of national collection drugs and coronary brackets were stable. In 2021, the cost of medical treatment was nearly 170 billion yuan. In some places, they actively organize the purchase of cross -provincial alliance concentration and guidance, and guide the gradient price reduction of uns selected drugs, which has also achieved significant results.

8. Continue to expand the scope of direct settlement and beneficiaries of the expenses of medical treatment

Direct settlement of medical expenses for different places is an effective measure to provide convenient and fast medical insurance services for the majority of insured personnel. On the basis of a different place for medical treatment for different places in recent years, the number of medical institutions and distribution scope of medical institutions that further access cross -provincial direct settlement systems in 2021 will be further expanded in 2021. As of the end of 2021, 53,000 medical institutions across the country have been connected to different places for medical treatment expenses and hospitalization. Each county has at least one medical institution with the system to realize the network. At the same time, comprehensive breakthroughs have also been made in direct settlement of ordinary outpatient expenses across provinces. It has covered all coordinated areas. It has been integrated with 128,000 pharmaceutical institutions, and more than 90%of the counties have more than one medical institution in the county to achieve networking with the system. Breakthroughs have also been made in direct settlement of slow special diseases for outpatient diseases. Five outpatient -related treatment expenses such as high blood pressure and diabetes have started the pilot work of cross -provincial direct settlement. In 2021, 64.34 million medical insurance participants in the country's medical insurance were medical treatment, and the cost of medical treatment in different places was 166.3 billion yuan. Residents' medical insurance insured persons have 43.18 million people in different places, and the cost of medical treatment for different places is 298.5 billion yuan. At the same time, the level of medical treatment services in different places has also improved significantly.

Nine, effectively strengthen the supervision of the medical security fund

The supervision of the medical security fund is related to the security of the fund. Effectively strengthening the fund supervision is a focus of the medical insurance department's work. The National Medical Insurance Bureau attaches great importance to strengthening the construction of the medical security fund supervision system and continuously improves the fund supervision mechanism. In 2021, he issued and implemented medical insurance regulations, administrative regulations, and a series of standardized documents such as the "Regulations on the Supervision and Administration of Medical Security Fund" and the "Interim Regulations on the Administrative Penalty Procedure of Medical Security", and a series of standardized documents to further improve the medical security system and promote the rule of law in order to promote the rule of law from the rule of law. It lays the foundation and effectively improves the level of fund supervision and standardization. On this basis, combine normal supervision with comprehensive supervision, improve the level of supervision in accordance with the law, and build a safety defense line of medical security funds. Through the organization and carrying out the full coverage of daily supervision and inspection, joint relevant departments to carry out the special rectification of fraud and fraud insurance, improve the "one case, joint punishment" mechanism, carry out the "clear zero action" of fund supervision stocks, organize a series of cross -regional cross -regional cross -regional cross -regional cross -region Flight inspections, stepped up the establishment of local reporting and award systems, and other measures, continuously improve and improve the medical security fund supervision system, seriously investigate and deal with various violations of laws and regulations, and effectively maintain the security of the fund. In 2021, the special inspection of the medical insurance administrative department and the daily inspection of the medical insurance agency agency to inspect a total of 708,000 medical institutions, handle 414,000 illegal institutions, handle 45,700 insured personnel, and recover a total of 23.418 billion yuan in medical insurance funds. At the same time, the National Medical Insurance Bureau organized a cross -regional flight inspection activity to find out 558 million yuan of suspected illegal funds. By vigorously strengthening the supervision of medical security funds, severely cracking down on various fraud insurance behaviors, and forming a high -pressure situation of continuously strengthening the supervision of medical security funds, it has played an important role in maintaining the safety of medical security funds in accordance with the law. 10. Steady exploration and establishment of long -term care insurance system

According to the central government's spirit of exploring the establishment of a long -term care insurance system, the State Medical Insurance Bureau organizes some areas to conduct a pilot work to explore the establishment of a long -term nursing insurance system to achieve preliminary results. On the basis of the original pilot, the State Medical Insurance Bureau decided to further expand the scope of the pilot in September 2020, and organized other provinces that did not carry out pilot to add 1 city to carry out pilots. In 2021, a total of 49 cities across the country carried out the establishment of long -term nursing insurance pilot work. The number of insureds in each pilot area increased to 144 million, the fund revenue was 26.06 billion yuan, the fund expenditure was 16.84 billion yuan, and 1.087 million people enjoyed long -term care insurance benefits. The annual reduction of the burden of related nursing costs is 155,000 yuan. According to the "Fourteenth Five -Year Plan" National Medical Security Plan issued by the General Office of the State Council in September 2021, it further clarifies that the long -term nursing insurance system will be steadily established in the future. The institutional system provides institutional guarantee for the development trend of active response to population aging and increasing the number of disabled personnel.

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