过去五年，我国医保改革成效显著，用数据说话：基本医保参保率稳定在95%以上，覆盖超13.6亿人；居民医保人均财政补助标准从2018年的490元提高到2023年的640元；累计开展8批国家组织药品集采，平均降价超50%，减轻群众用药负担超3000亿元；跨省异地就医直接结算覆盖全国所有统筹地区，惠及超1亿人次。同时，医保基金监管持续强化，追回资金超700亿元，守护了群众的“看病钱”。展望2024年，医保改革将聚焦高质量发展：一是推进医保支付方式改革，扩大DRG/DIP付费试点范围；二是加快医保目录动态调整，更多创新药、罕见病药有望纳入报销；三是优化异地就医服务，推动门诊慢特病费用跨省直接结算全覆盖；四是加强基金监管智能化，提升欺诈骗保打击精准度。通过制度完善与技术创新，医保体系将更公平、更高效、更可持续，切实增强人民群众的获得感、幸福感和安全感。
Over the past five years, China’s medical insurance reform has achieved remarkable results, as evidenced by key statistics: basic medical insurance coverage has remained above 95%, benefiting more than 1.36 billion people; per capita government subsidies for residents’ medical insurance rose from RMB 490 in 2018 to RMB 640 in 2023; eight rounds of national centralized drug procurement have been implemented, cutting average drug prices by over 50% and reducing patients’ medication costs by more than RMB 300 billion; direct cross-provincial settlement for medical expenses is now available nationwide, serving over 100 million individuals. Additionally, enhanced fund supervision has recovered over RMB 70 billion, safeguarding public healthcare funds.Looking ahead to 2024, reforms will focus on high-quality development: first, advancing payment method reforms by expanding DRG/DIP pilot programs; second, accelerating dynamic updates to the reimbursement drug list to include more innovative and rare-disease treatments; third, improving cross-provincial access by achieving full coverage for direct settlement of outpatient chronic and special disease expenses; and fourth, strengthening intelligent fund oversight to more precisely combat fraud and abuse. Through institutional refinement and technological innovation, China’s medical insurance system will become fairer, more efficient, and more sustainable—enhancing public well-being, satisfaction, and security.
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