CCTV News: The reporter learned from the National Health Insurance Administration on March 11 that as of the end of February, a total of 103 coordinated regions across the country carried out instant settlement of medical insurance funds for medical institutions, accounting for 26% of the total number of coordinated regions, and the amount of instant settlement allocation was 38.731 billion yuan.

In January 2025, the National Medical Insurance Administration issued the "Notice on Promoting the Reform of Real-time Settlement of Basic Medical Insurance Funds", requiring all provinces to strictly implement medical insurance fund prepayment and promote real-time settlement. As of the end of February, a total of 103 coordinated areas across the country carried out instant settlement, among which Anhui, Shandong, Guangdong, Henan, Qinghai and other provinces were the first to issue provincial instant settlement documents.

In terms of policy coordination, fund prepayment and instant settlement are synergistically empowered. As of the end of February, 29 provinces have established an advance payment system, and 17 provinces have prepaid basic medical insurance funds of 48.4 billion yuan. Other eligible coordinated areas will complete the allocation before the end of March.

In the settlement path, 79 coordinated areas further increase the allocation frequency on the basis of shortening the monthly settlement time. Anhui summarizes the hospitalization costs one by one, and the next day it will be allocated to the hospital at a rate of 60%. Xiamen, Fujian uses the form of daily newspapers, daily reviews and daily allocations to shorten the fund allocation time limit to a minimum of 1 working day.

From the fund scope, 61 coordinated regions have expanded the scope of instant settlement funds to serious illness insurance funds or medical assistance funds.

From the implementation effect, instant settlement has eased the pressure on advance payments for medical institutions. At the same time, we will promote designated medical institutions to accelerate the collection of funds to pharmaceutical companies and promote the improvement of the overall capital turnover efficiency of the pharmaceutical industry. Instant settlement of medical insurance funds to reduce the financial pressure of hospitals

For a long time, "slow payment collection" has been a long-standing problem in the medical field. According to the National Health Insurance Administration, in 2025, my country will comprehensively promote the reform of real-time settlement of basic medical insurance funds and accelerate the capital turnover of medical institutions and pharmaceutical enterprises. At present, some regions across the country have launched pilot work. What changes can this reform bring?

In January 2025, Anhui Province fully implemented the instant settlement model of medical insurance funds, and the allocation time limit for medical insurance funds was compressed to about 1 working day. As the first batch of pilot units, Hefei First People's Hospital has now achieved the medical insurance funds being credited the next day after the patient is discharged.

For a long time, since the medical insurance fund adopts a "postpayment system" for settlement of medical institutions, it usually takes 60 days for a medical insurance to pay to the hospital account after the patient is discharged from the hospital. Like Hefei First People's Hospital, in the past, it had to advance medical insurance funds of about 50 million yuan each month.

With the implementation of the reform of instant settlement of medical insurance funds, the "post-payment system" has become the "cash payment system", and the cash flow problems of hospitals have been significantly improved.

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; in 2026, all coordinated areas in the country will realize instant settlement of basic medical insurance funds and designated medical institutions. Build a "one-stop" platform for medical insurance and commercial insurance to settle simultaneously

Some patients who have bought commercial medical insurance may have such experience. After the hospital has completed the settlement, they have to take various notes to the insurance company to settle claims. This is not only time-consuming and laborious, but also has to make money first. To this end, while promoting instant settlement and direct settlement between medical insurance funds and medical institutions and pharmaceutical companies, the National Medical Insurance Administration has promoted the pilot of simultaneous settlement of medical insurance and commercial insurance in various places.

In recent years, many places in Shandong have begun to build "one-stop" platforms for medical insurance and commercial insurance, and patients can achieve synchronous settlement at one time at the hospital window. Ms. Yu's family in Yantai were discharged from the hospital not long ago. When handling the settlement, Ms. Yu found that in addition to basic medical insurance, the "health insurance" purchased by her family also received claims.

Such "smooth and senseless" settlement and payment comes from the integrated and synchronous settlement of Shandong basic medical insurance and commercial medical insurance. In the past, commercial medical insurance claims not only had many processes and required a lot of information, but insured patients also had to pay the fee first. In this regard, in the claim settlement of commercial medical insurance "Yantai Citizen Health Insurance" by the Yantai Municipal Medical Insurance Bureau has broken the data barriers between medical insurance, commercial insurance, medical institutions and insured persons through big data and blockchain technology, and established an integrated platform for medical insurance and commercial insurance.

At present, Guangdong, Jiangsu and other places are also piloting the simultaneous settlement and payment of medical insurance and commercial insurance, but most of the commercial insurance is the local specific inclusive medical insurance, just like Shandong. In Shanghai, the medical insurance commercial insurance synchronous settlement service platform piloted in September 2024 has been connected to 12 Grade A hospitals.

The National Health Insurance Administration stated that in 2025, it will vigorously promote the effective connection between commercial health insurance and basic medical insurance. Areas with conditions are encouraged to explore the development of commercial health insurance into hospitals, and achieve "one-stop" settlement with basic medical insurance, serious illness insurance, and medical assistance.