The National Healthcare Security Administration (NHSA) last week held a press conference, addressing questions regarding the medical insurance operation status in 2024 and outlining the 2025 work plan. The conference provided detailed insights into the performance of the national basic medical insurance (BMI) fund and future policy directions.
2024 Medical Insurance Fund Operations
The total revenue of the national basic medical insurance (BMI) fund reached RMB 3.48 trillion (USD 475.7 billion), marking a 4.4% year-on-year (YOY) increase. Specifically, the employee medical insurance fund generated RMB 2.37 trillion (USD 324 billion), while the resident medical insurance fund contributed RMB 1.11 trillion (USD 151.7 billion). The total expenditure of the national medical insurance fund was RMB 2.97 trillion (USD 406 billion), up 5.5% YOY.
Long-term Care Insurance Development
Regarding long-term care insurance, the press conference highlighted that since the pilot program launched in 2016, the system has covered 180 million people. Over 2.6 million disabled insured persons have benefited, with fund expenditures exceeding RMB 80 billion (USD 109.4 billion).
DRG/DIP Reform and Fertility Policy
In terms of DRG/DIP reform, the 2.0 grouping scheme was launched ahead of schedule in 116 coordinated regions by December last year, with the remaining regions switching grouping versions on time in early January this year. More than 95% of overall planning areas have established mechanisms for special case discussions, opinion collection, communication, negotiation, and data working groups.
Regarding fertility policy, 31 provinces and military units across the country have included assisted reproduction in medical insurance, benefiting over one million people by 2024.
Anti-Corruption and Price Management
Significant progress has been made in anti-corruption and price management in the pharmaceutical industry. Credit rating, graded disposal, credit repair, and centralized procurement have been implemented to reduce inflated drug prices. The management of online prices for “four identical drugs” has been standardized, covering over 27,000 drug specifications. In 2025, the government will continue to promote volume-based procurement (VBP), including the 11th VBP round in the first half of the year and the 6th round of high-value medical consumables VBP in the second half. The number of drug procurement varieties is expected to reach 700.
Innovative Drug Support and NRDL Adjustments
To support innovative drugs, the NHSA emphasized the need to strengthen strategic medical insurance purchases and empower pharmaceutical industry innovation. Over the past seven years, the National Reimbursement Drug List (NRDL) has added 835 new and high-quality drugs, with a record 38 “global new” innovative drugs added last year.
The NHSA proposed exploring the formation of a Class C drug catalog, focusing on drugs with high innovation, significant clinical value, and substantial patient benefits, but temporarily unable to be included in the basic medical insurance catalog due to exceeding the “basic insurance” positioning. The government plans to optimize payment management policies for Class C drugs, potentially excluding them from self-payment rates and VBP monitoring. The first version of the Class C catalog is planned to be released this year, with adjustments synchronized with the annual basic medical insurance drug catalog.-Fineline Info & Tech
Leave a Reply