Qiangji solid background -see medical insurance through data 2021

The State Medical Insurance Bureau recently released the "Statistics of the National Medical Security Development Statistics of 2021" (hereinafter referred to as the "Statistics Bulletin"). Judging from the data published by the Statistical Bulletin, the basic situation of medical insurance coverage is still firm, the fund operation is safe and stable, the functional effects of medical insurance are effective, the characteristics of the strategic buyer of medical insurance are increasingly prominent, and the people have obtained more medical insurance Beneficial. All of this, which not only took a good head and step by step for the implementation of the "14th Five -Year Plan" of medical insurance, but also brought about the challenges brought about by the increasingly serious population aging in my country, consolidated the financial foundation, and made policy preparations for policy preparations. , Thus accumulating stamina for the smooth operation of the medical insurance industry and sustainable development.

1. The foundation of smooth operation is thicker

For our country, whether the medical insurance system is running smoothly, it can be judged by three indicators: First, whether the system covers the surface is always maintained at a higher level, reflecting the degree of recognition of the system by the people, that is, the masses of the system of the system, that is, the mass foundation of the system of the system Second, whether the financial situation of the system has always maintained well, it reflects the economic foundation for the sustainable development of the system; the third is whether the information technology has been fully applied in the medical insurance system, which reflects the technical foundation of medical insurance management services. Due to the relatively high requirements for the application of medical insurance information system direct settlement in different places, direct settlement data for medical treatment can to a certain extent reflect the extent and ability of the application information technology of medical insurance departments to a certain extent.

(1) The overall coverage of medical insurance is very stable

According to the data released by the Statistical Bulletin, as of the end of 2021, the number of basic medical insurance participants in the country was 1362.97 million. According to the data released by the Statistics of the National Economic and Social Development of 2021, as of the end of 2021, the country's population was 1412.6 million. Based on this calculation, the basic medical insurance participation rate in 2021 reached 96.49%. If the person who is not in the scope of the insurance (such as active soldiers, etc.), the actual insurance rate will be higher. Since the establishment of the State Medical Insurance Bureau in 2018, the insured rate has been stabilized by more than 95%, indicating that the situation of medical insurance coverage is very stable.

Look at another set of data. As of the end of 2021, the number of employees' medical insurance insured was 35.431 million, an increase of 9.76 million over the previous year. Generally speaking, the number of participants in 2021 increased by 1.66 million compared with 2020 (the number of insureds in 2020 was 136.131 million). It means that more people who participated in the medical insurance of urban and rural residents chose to participate in the medical insurance with higher levels of treatment, indicating that the people's awareness of medical insurance is constantly improving.

(2) The financial status of the medical insurance system is generally good

In 2021, the income growth rate of basic medical insurance (including maternity insurance) funds was 15.6%, which was slightly higher than 14.3%of the fund expenditure growth rate. Continue to maintain the basic situation of "balance of revenue and expenditure, slightly balanced", indicating that the medical insurance system was running smoothly, finance The situation is generally good, providing capital guarantee for the sustainable development of medical insurance.

As of the end of 2021, the national basic medical insurance (including maternity insurance) funds cumulatively deposited 3615.63 billion yuan, and the cumulative deposit amount was 465.63 billion yuan in the previous year. Deepening reform has laid a solid economic foundation.

(3) Direct settlement of medical treatment is widely carried out extensively

It is understood that at present, all the overall regions have been opened for direct settlement of hospitalization and ordinary outpatient expenses across provinces. In 2021, there were 45,600 designated medical institutions that have opened online direct settlement for medical expenses, which were 0.12 million more than 2020; 82,700 fixed retail pharmacies with direct settlement of medical expenses, and the outpatient costs directly settled by 9.966 million people across provinces. ; Residential expenses were directly settled by 4.4.059 million, which was 1.4036 million more than 2020.

Behind the boring numbers is the practical protection of medical rights in patients with tens of millions of different places, and all these medical insurance rights can smoothly achieve technical support provided by powerful medical insurance information systems. This also illustrates from one aspect that after years of hard work, the development of medical insurance has provided a strong medical security information system to provide technical support, thereby effectively guaranteeing and promoting the continuous improvement of medical insurance management services.

2. Consolidation and improvement of medical insurance treatment of the people

Since the establishment of the medical insurance bureaus at all levels, it has adhered to the service concept of people's health, putting the safety of people's life safety and physical health, and striving to improve and continuously consolidate the people's medical insurance treatment. Carrying out, the level of protection has been steadily improved, and the people's medical insurance sense, happiness, and security have improved significantly. From the data point of view, in 2021, the national medical insurance work remains and continues this situation.

(1) The drug directory continues to expand capacity

In 2021, a total of 2,860 western medicines and Chinese medicines issued "Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drugs (2021)" issued by the State Medical Insurance Administration. Incident 74 medicines. There are 892 types of Chinese medicine drinks. This is the third consecutive year that the State Medical Insurance Bureau has released the medical insurance catalog for the third consecutive year. It is also the third consecutive time that the medical insurance drug catalog has been implemented dynamically and the total amount is expanding. More medicines are included in the medical insurance catalog, which means that the people can enjoy more affordable and better medical insurance. It is particularly worth mentioning that since the establishment of the State Medical Insurance Bureau in 2018, it has given full play to the functions of the medical insurance department, and conducts four consecutive times of medical insurance drug directory negotiations. A total of 250 drugs have been added to the directory through negotiations. More than 50%. In 2021, 221 negotiated drugs were reimbursed during the agreement period. By negotiating price cuts and medical insurance reimbursement, a total of 149.49 billion yuan was reduced to patients during the year.

(2) Continuous development of collection work

In order to further reduce the cost of the people's use of drugs and medicinal consumables, the medical insurance department has made full use of it as a medical service to purchase a third -party group purchasing power, and continues to organize the centralized and volume of drugs and medical consumables, and the price of drug consumption has been further reduced.

According to the data released by the Statistical Bulletin, in 2021, the procurement of three batches of national organizational drugs was carried out, involving 122 varieties, with an average price reduction of 52%. Carry out the national organization of artificial joints. The average price of hip joints has been reduced from 35,000 yuan to about 7,000 yuan. The average price of knee joints has been reduced from 32,000 yuan to about 5,000 yuan, with an average price reduction of 82%. It is understood that the average price reduction of 42 insulin special collection varieties is 48 %, coupled with the price reduction of artificial hip joints and knee joint collection products, it is expected to benefit nearly 11 million patients and reduce the burden of nearly 30 billion yuan each year; the first five batches of national sets Drug collection and coronary brackets saved nearly 170 billion yuan in drug consumption costs in 2021.

(3) The level of guarantee continues to consolidate

With the continuous improvement of my country's basic medical security system, the level of benefits of insured people at 2021 has been further consolidated. It is mainly reflected in the following three aspects:

First, the payment ratio of hospitalization expenses fund within the scope of employee medical insurance policy is 84.4%, of which: three -level, second, and first -level medical institution policy within the policy scope of medical institutions is 83.4%, 86.9%, and 87.9%; residents' medical insurance policy The payment ratio of hospitalization expenses within the scope is 69.3%, of which: three, second, first, and below medical institutions within the policy scope of medical institutions are 64.9%, 72.6%, and 77.4%, respectively. The proportion of reimbursement in hospitalization medical expenses within the scope of the policy scope of patients participating in the insurance continues to be maintained in a reasonable horizontal interval.

The second is to enjoy 13.21 million people for each maternity insurance, an increase of 1.54 million over the previous year, an increase of 13.2%over the previous year. The per capita fertility treatment expenditure of maternity insurance was 22,261 yuan, an increase of 1.3%over the previous year.

Third, 101.26 million people were implemented in the country's cumulative implementation of outpatients and hospitalization, an increase of 17.22 million passengers over the previous year; the average hospital rescue assistance was 1,074 yuan, an increase of 18 yuan over the previous year.

3. Facing the future challenge of medical insurance

With the continuous deepening of my country's aging, the medical insurance fund will face increasingly serious payment pressure, and the sustainability of the system will also face increasingly severe challenges. It is urgent to plan for the medical insurance department to prepare for the future to deal with the future in advance The preparations of all the risks and challenges of all the items and unknown. To this end, the medical insurance department focused on the following three tasks in 2021:

(1) Comprehensive start -up reform of medical insurance payment methods

As of the end of 2021, 30 national pilot cities and 71 regional points method budget budgets and pilot cities of diseases (DIP) were paid by the national pilot cities and 71 regional points in the country.

It is understood that the three -year pilot has achieved significant results. The medical expenses expenses of pilot cities, especially the continuous and rapid growth trend of hospitalization expenses, have been effectively controlled, the proportion of self -funding of the insurers has decreased, the burden of medical expenses is reduced, the medical insurance fund’s of the medical insurance fund The further improvement of the use efficiency has also played a role in regulating the medical service market to a certain extent, promoting hierarchical diagnosis and treatment, forming a scientific and orderly medical pattern, promoting and supporting the healthy development of medical and health undertakings, and initially realized the medical-insurance-suffering A win -win situation of the three parties.

In order to further expand the effectiveness of the pilot and accelerate the establishment of an efficient medical insurance payment mechanism for a whole set of pipes, on November 19, 2021, the State Medical Insurance Bureau issued the "DRG/DIP Payment Method Reform Action Plan" on November 191. , That is: from 2022 to 2024, the DRG/DIP payment method reform tasks are fully completed. By the end of 2024, all the overall regions of the country will carry out the reform of DRG/DIP payment methods; by the end of 2025, the DRG/DIP payment method will cover all qualified medical institutions that meet the qualified hospitalization services, and basically achieve the full coverage of the disease and medical insurance funds.

(2) Normal institutionalization of fund supervision

The medical insurance fund is the economic basis for the normal operation of the medical insurance system. Only fund security can ensure that the system is stable and far away. Strengthening the supervision of the medical insurance fund is an important measure to maintain the safety of the medical insurance fund and promote the effective use of medical insurance funds, and it is also a necessary means to safeguard the legitimate rights and interests of the people's medical insurance. For a long time, the Party Central Committee and the State Council have always attached great importance to the supervision of the medical insurance fund, made a series of important decision -making deployments, and awarded a series of regulatory documents. Since the establishment of the National Medical Insurance Bureau, it has organized a series of major actions to strengthen fund supervision. The normalization, institutionalized, standardized, and systematic supervision of medical insurance fund supervision work system has initially formed, so as to be the stable, healthy and sustainable development of the medical insurance industry It laid a very important basis for administrative management. In 2021, the medical insurance department continued to conduct special inspections of the administrative department and the daily inspection of the medical insurance agency. The results were still significant, and the medical insurance fund was safer. According to the data released by the Statistics, the national medical insurance department inspected a total of 708,000 medical institutions in 2021, handled 414,000 illegal institutions, of which 4,181 medical insurance service agreements were lifted, 7088 administrative penalties were transferred, and 404 were transferred to judicial organs. ; 4,5704 insured personnel, of which 6,472 were suspended from medical expenses, and 1789 were transferred to judicial organs. A total of 23.418 billion yuan in medical insurance funds was recovered throughout the year. Organize 30 flights for flight inspections, inspect 68 designated medical institutions and 30 medical insurance agencies, and find out 558 million yuan of suspected illegal funds.

(3) Orderly promote long -term care insurance work

According to the data released by the "Seventh Census Statistical Bulletin", with the standard point at 00:00 on November 1, 2020, the total population of my country is 1.44 billion, and the population of 60 and over accounts for 18.7%of the total population, of which: 65 years old: 65 years old The population above accounts for 13.5%of the total population. The above data shows that my country has arrived at the door of a deep aging society, and will soon enter the real aging society in the true sense. With the continuous deepening of my country's population aging, the number of elderly people who have lost their self -care ability due to the weakness and illness of the old body will continue to increase. In the reality of the acceleration of population flow and the miniaturization of the family structure, the demand for long -term care services will become increasingly increasingly socialized care services. The more urgent.

The State Medical Insurance Bureau attaches great importance to long -term care insurance work. While fully affirming the preliminary results of long -term nursing insurance pilots, it has achieved preliminary results, and in 2020, it has made major decision -making deployments to further expand the pilot of long -term care insurance systems. According to statistics, in 2021, the number of long -term nursing insurers in 49 pilot cities across the country was 144.66 million, and the number of people enjoyed 1.087 million. In 2021, the fund revenue was 26.06 billion yuan, and the fund expenditure was 16.84 billion yuan. Long -term care insurance designated service agencies 6819. Nursing service staff 302,000.

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