State Council Information Office Press Conference: In the next 5 years, medical insurance reimbursement and long-term care insurance will see new changes!

On the morning of September 4, the State Council Information Office held a press conference in the series themed ‘Starting the Journey of the 15th Five-Year Plan,’ introducing progress in promoting high-quality development of medical insurance and better serving the cause of Chinese-style modernization.

The National Healthcare Security Administration has made clear

the key tasks for medical insurance during the 15th Five-Year Plan

A relevant official from the National Healthcare Security Administration introduced that during the 15th Five-Year Plan period:

• the medical insurance authorities will continue to consolidate the foundation of universal medical insurance and continuously optimize the structure of universal enrollment,expanding the scale of participation in employee medical insurance among key groups such as flexible employment personnel, migrant workers, and workers in new forms of employment.

• Continuously improve the level of maternity medical security,achieve direct settlement of maternity medical expenses for insured persons and direct payment of maternity allowances to individuals.

• Comprehensively establish the long-term care insurance system, improve long-term care insurance service policies, and promote the enhancement of long-term care service capacity and level.

• At the same time, the medical insurance authorities will also deepen the reform of payment methods to help medical institutions improve quality and efficiency; carry out centralized bulk procurement of drugs and medical consumables in a standardized, institutionalized, and regular manner, and comprehensively promote the application of the drug price comparison mini-program in designated pharmacies; standardize the management of the medical insurance catalog, increase support for innovative drugs, medical devices, and innovative services, and promote the going global of Chinese medicine; continuously strengthen fund supervision and enhance full-process fund management.

In addition, deepen the ‘efficient handling of one matter’ in the medical insurance field, and realize ‘handling high-frequency matters in other places and nearby’;comprehensively deepen the application of facial recognition payment, one-code payment, mobile payment, and credit payment, realize the mutual aid use of individual accounts of employee medical insurance,promote the convenience and diversification of medical insurance public service supply, and optimize the public’s medical insurance service experience.

Adjustment of the Medical Insurance Drug Catalog

A cumulative total of 199 innovative drugs have been included

Since 2018,we have continuously improved the dynamic adjustment mechanism of the medical insurance drug catalog,adding a cumulative total of 949 drugs, of which 199 are innovative drugs,so that more patients can access and afford life-saving and emergency medicines.

Facing the new situation of the rapid development of the pharmaceutical industry during the 15th Five-Year Plan period,the medical insurance authorities will continue to adjust the basic medical insurance drug catalog every year, including more eligible innovative drugs for major diseases and key areas such as tumors, chronic diseases, rare diseases, and pediatric diseases in medical insurance reimbursement.At the same time, optimize and improve the commercial health insurance innovative drug catalog. For innovative drugs that are beyond the scope of basic medical insurance, have a high degree of innovation, significant clinical value, and notable patient benefits, commercial medical insurance and other payers are recommended to pay first.

By the end of 2028, the long-term care insurance system

will achieve basically full nationwide coverage

As of now,22 provinces have issued provincial-level long-term care insurance implementation plans, and the number of pooled areas with established systems has reached 121,among them, Hainan Province has been unified from the start, simultaneously including both employees and urban and rural residents in the system’s coverage,It is expected that by the end of this year, the number will expand to 247 pooled areas nationwide.

A relevant official from the National Healthcare Security Administration stated,By the end of 2028, the long-term care insurance system should achieve basically full nationwide coverage.Following the principle of coordinating urban and rural areas and covering all citizens, accelerate the expansion of coverage from employees to urban and rural residents.

Flexible employment personnel, etc.

It will be more convenient to participate in employee medical insurance

At present, active exploration has been carried out in industries such as food delivery, express delivery, ride-hailing, and domestic services regarding participation and payment methods for workers in new forms of employment,Platform enterprises have actively assumed responsibility, achieving certain results in reducing the payment burden on workers. Through these efforts, the scale of flexible employment personnel participating in employee medical insurance has continued to grow.

In response to the characteristics of flexible employment personnel, such as frequent changes in work and location, a series of measures will be introduced,Continue to promote the comprehensive elimination of household registration restrictions for participating in insurance at the place of employment or residence in megacities.

At the same time, exploreconverting the years of continuous participation in resident medical insurance into local employee medical insurance years,and allow their employee medical insurance contribution years to be accumulated on a monthly basis, counting all scattered contribution periods into the employee medical insurance contribution years, so that upon reaching the statutory retirement age and required contribution years, they can enjoy retirement medical insurance benefits.

In the first 7 months of this year

maternity insurance benefited 25.56 million person-times

As of now, the number of people covered by maternity insurance has reached 260 million. 193 coordinated regions in 22 provinces have included flexible workers in the coverage, 303 coordinated regions in 28 provinces have implemented the policy of ‘no out-of-pocket payment’ for individual hospitalization delivery costs within the policy scope, and all provinces have included appropriate assisted reproductive technologies in the payment scope, fully realizing the inclusion of labor analgesia in medical insurance reimbursement.In the first seven months of this year, the maternity insurance fund expenditure was 78.42 billion yuan, benefiting 25.56 million person-times, of which maternity allowance expenditure was 60.78 billion yuan, fully realizing direct payment to individuals.

Based on the ’15th Five-Year Plan’, the medical insurance department will vigorously promote the participation of flexible workers, migrant workers, and new employment form personnel who participate in employee medical insurance in maternity insurance simultaneously,so that more couriers, ride-hailing drivers, freelancers, etc. can enjoy maternity insurance protection,being able to both reimburse medical expenses and receive maternity allowances.

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