From "monthly calculation" to "next-day delivery", what are the benefits of instant settlement of medical insurance funds?

Medical insurance funds are not only the medical treatment and life-saving money for the people, but also the empowerment fund for the development of the pharmaceutical industry.

In actual operation, the medical insurance foundation has contacts with medical institutions (hospitals), pharmaceutical companies, and commercial insurance companies and other fields and institutions, whether the medical insurance fund can settle payments in a timely manner will be transmitted downward to relevant institutions and enterprises in the entire industry chain. For these institutions and enterprises, the faster the settlement of funds, the better. But for a long time, "slow payment collection" has been a long-standing problem in the pharmaceutical field.

The reporter recently learned from the National Health Insurance Administration that this year, my country will comprehensively promote the reform of real-time settlement of basic medical insurance funds, alleviate the pressure of capital turnover of medical institutions, and support the high-quality development of medical institutions and the pharmaceutical industry.

The National Health Insurance Administration recently issued a notice clearly stated that it is necessary to greatly optimize the settlement of medical insurance funds in the two years from 2025 to 2026. The goal is to greatly improve the speed of medical insurance settlement and completely change the previous situation of slow settlement.

According to requirements, by 2025, about 80% of the coordinated areas in the country will basically realize instant settlement of basic medical insurance funds and designated medical institutions, and in 2026, all coordinated areas in the country will realize instant settlement of basic medical insurance funds and designated medical institutions.

What fees are included in the settlement scope? What are the requirements for settlement time limit?

Let's learn about the settlement content determined this time:

In terms of fund scope: basic medical insurance fund. Including employee medical insurance funds and urban and rural residents' medical insurance funds. Places with conditions are encouraged to expand the scope of funds;

In terms of settlement scope: medical expenses incurred by designated medical institutions. Including medical expenses such as general outpatient clinics, outpatient chronic diseases, hospitalization, fertility, and drug purchases in pharmacies;