近日，国家医保局正式启动‘个人医保云’建设试点工作，标志着我国医保服务向数字化、智能化迈出关键一步。‘个人医保云’旨在通过统一的数据平台，整合参保人在全国范围内的医保信息，实现医保账户、就诊记录、药品目录、费用结算等数据的实时归集与共享。试点将首先在部分省市展开，重点探索跨区域医保结算、个人健康档案管理、智能报销审核等应用场景。该平台建成后，参保人可通过手机App或小程序随时查看个人医保权益、历史就医记录，并在线办理异地就医备案、费用报销等业务，大幅提升办事效率和体验。同时，‘个人医保云’还将为医保基金监管、精准施策和公共卫生决策提供数据支撑，助力构建更加公平、高效、可持续的医疗保障体系。此次试点是落实‘数字中国’战略、推动医保高质量发展的重要举措，未来有望在全国范围内推广。
Recently, China’s National Healthcare Security Administration (NHSA) officially launched a pilot program for the construction of the ‘Personal Medical Insurance Cloud,’ marking a critical step toward digitalizing and intelligentizing the country’s healthcare insurance services. The ‘Personal Medical Insurance Cloud’ aims to create a unified data platform that integrates individuals’ medical insurance information nationwide, enabling real-time aggregation and sharing of data such as insurance accounts, medical visit records, drug formularies, and expense settlements.The pilot will initially roll out in selected provinces and cities, focusing on use cases like cross-regional insurance settlement, personal health record management, and AI-assisted reimbursement auditing. Once fully implemented, insured individuals will be able to access their insurance benefits and medical history anytime via mobile apps or mini-programs, and handle services such as out-of-area medical care registration and claim submissions online—significantly improving efficiency and user experience. Additionally, the platform will support fund oversight, targeted policy-making, and public health decision-making with robust data analytics. This initiative is a key part of China’s ‘Digital China’ strategy and represents a significant move toward high-quality development of the national healthcare security system, with plans for nationwide expansion in the future.
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