A national conference on healthcare security was recently held in Beijing, reviewing the achievements of 2024 and setting the agenda for 2025. The conference highlighted new developments in medical reform across various fronts.
Advancements in Medical Reform in 2024
Universal Insurance Coverage
The conference reported that universal insurance coverage has entered a new phase, with the acceleration of a long-term mechanism for basic medical insurance. Restrictions on insurance participation based on residency have been eased, and an incentive and constraint mechanism for insurance payment has been established.
Expanded Insurance Coverage
Employee medical insurance personal accounts are now accessible to close relatives, and funds can be used across provinces. The top-level design for a long-term care insurance system is underway, and maternity insurance coverage is being consolidated and expanded.
New Medical Insurance Payment Mechanism
The National Reimbursement Drug List (NRDL) has been adjusted for seven consecutive years, reaching 3159 drugs. Assisted reproductive projects are now covered in 29 provinces. The DRG/DIP payment 2.0 grouping scheme has been introduced, along with supporting mechanisms such as special case negotiation and prepayment.
Price Management Measures
The tenth round of volume-based procurement (VBP) for drugs and the fifth round for high-value medical consumables have been conducted. National joint procurement for Chinese herbal pieces and traditional Chinese patent medicines has been guided. Open price comparison of NRDL drugs in designated pharmacies has been implemented, and national medical service price items have been unified and standardized.
Fund Supervision and Management Services
Fund supervision has been intensified, recovering RMB 24.23 billion in medical insurance funds. Big data regulatory models have been innovated, and a medical insurance payment qualification management system has been introduced.
Medical Reforms Galvanized for 2025
Strengthening Medical Insurance Fund Operations
The government pledges to strengthen the operation and management of the medical insurance fund, ensuring its safety and adherence to the principle of balanced income and expenditure.
Improving Multi-Level Healthcare Security System
The conference emphasized the need to build a medical insurance infrastructure supported by a unified national medical insurance information platform and big data.
Meeting New Expectations for Health Empowerment
Efforts will be made to accelerate the establishment of a long-term care insurance system with Chinese characteristics and improve配套 policies.
Optimizing Medical Insurance Payment Mechanism
The DRG/DIP2.0 grouping scheme will be promoted, and real-time settlement between medical insurance and designated medical institutions will be encouraged.
Strengthening Strategic Procurement and Empowering Pharmaceutical Innovation
More new and good drugs will be included in the NRDL, supporting innovation and genuine innovation in the pharmaceutical industry.
Deepening Pharmaceutical Price Reform and Regulation
The conference called for the promotion of online drug price governance and the establishment of a national consensus on drug online price rules.
Strengthening Medical Insurance Fund Supervision
Focus will be on inspecting areas with high risk of fund deficit and promoting the full scenario application of drug consumables traceability codes.
Optimizing Medical Insurance Management Services
The service capacity of grassroots medical insurance will be enhanced, and key tasks in the medical insurance field will be promoted to be more beneficial to the people and enterprises.-Fineline Info & Tech
