2024年医疗保障事业发展统计快报
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2024年，国家医保局坚持以习近平新时代中国特色社会主义思想为指导，深入学习贯彻党的二十大和二十届二中、三中全会精神，全面落实中央经济工作会议部署，按照党中央、国务院决策部署，稳中求进、深化改革，将学习贯彻习近平新时代中国特色社会主义思想主题教育和党纪学习教育成果转化为医保改革发展惠民实效，推动医疗保障事业步入新征程。 一、基本医疗保险稳健运行 （一）参保人员情况 截至2024年底，基本医疗保险参保人数达132637.83万人，参保质量持续提升，参保结构更加优化，参保率巩固在95%。 （二）基金收支情况 2024年，基本医疗保险基金（含生育保险）总收入、总支出分别为34809.95亿元、29675.92亿元。 职工基本医疗保险基金（含生育保险）收入23671.59亿元，其中统筹基金收入17368.93亿元；基金支出19056.55亿元，其中统筹基金支出13205.04亿元。 城乡居民基本医疗保险基金收入11138.36亿元，支出10619.38亿元。 （三）待遇享受情况[1] 2024年享受门诊待遇总人次66.89亿人次，同比增长37.44%，其中职工享受门诊待遇总人次35.29亿人次，同比增长43.82%，居民享受门诊待遇总人次31.60亿人次，同比增长30.95%；享受住院待遇总人次29182.26万人次，同比增长4.48%，其中职工享受住院待遇总人次8652.23万人次，同比增长8.03%，居民享受住院待遇总人次20530.03万人次，同比增长3.05%；次均住院费用8443.63元，其中职工11169.11元，居民7295.00元。 二、生育保险助力降低生育成本 截至2024年底，生育保险参保人数25297.51万人，同比增加390.45万人。生育保险基金待遇支出1431.78亿元，比上年增加362.68亿元，增长33.92%。 三、医保助力乡村振兴成效显著 2024年，原承担医保脱贫攻坚任务的25个省份享受参保资助约8622.8万人，其中医疗救助渠道资助参保7190.9万人，其他渠道当年累计资助1589.7万人，重叠享受两种渠道资助约157.7万人。资助参保支出175.1亿元，其中医疗救助当年累计支出146.3亿元，其他渠道当年累计支出28.8亿元。农村低收入人口和脱贫人口参保率稳定在99%以上。基本医疗保险、大病保险、医疗救助三重制度累计惠及农村低收入人口就医21831.7万人次，减轻医疗费用负担1961.61 亿元。 四、异地就医直接结算便捷群众生活和工作 截至2024年底，跨省联网定点医药机构64.40万家，其中跨省联网定点医疗机构23.03万家，跨省联网定点零售药店41.37万家。 2024年，全国住院费用跨省直接结算1433.56万人次，基金支付1586.73亿元，比2023年结算人次增长27.37%，基金支付同比增长17.43%；全国门诊(包含普通门诊、门诊慢特病、药店购药)费用跨省直接结算2.24亿人次，基金支付360.51亿元，比2023年结算人次增长90.18%，基金支付同比增长94.36%。 五、医保药品目录扩容惠及更多患者 《国家基本医疗保险、工伤保险和生育保险药品目录（2024年）》收载西药和中成药共3159种，西药1765种，中成药1394种，另含中药饮片892种。自2018年国家医保局成立以来，连续7年开展医保药品目录动态调整，累计835种药品新增进入目录范围，其中2024年新增91种。2024年，协议期内397种谈判药报销2.8亿人次。 六、支付方式改革减少患者看病就医负担 截至2024年底，按病种付费覆盖全国所有统筹地区，按病种付费的医保基金支出占统筹地区内住院医保基金支出超八成。116个统筹地区上线按病种付费2.0版分组方案，九成以上的统筹地区建立了特例单议、谈判协商机制，所有统筹地区建立了医保数据工作组。 七、价格改革和招标采购推动“三医”协同发展 常态化运行医疗服务价格动态调整机制，各省均开展调价评估，11个省份启动动态调价，5个省份启动专项调价，发布20批立项指南。滚动推进6批药品、3批耗材风险处置，有力有效处置一批虚构成本、以缺逼涨、垄断控销等导致的价格异常问题。 开展第十批国家组织药品集采，涉及62个品种；开展第五批国家组织高值医用耗材集采，纳入人工耳蜗和外周血管支架2类品种。同时，指导山东省牵头开展中药饮片全国联采，涉及45 种药品，指导湖北牵头开展中成药全国联采，涉及 175 种药品。截至2024年底，各省份的国家组织和省级集采药品品种数达到500个以上，提前完成“十四五”规划目标。 2024年，全国通过省级医药集中采购平台网采订单总金额9962亿元。其中，西药（化学药品及生物制品）7902亿元；中成药2060亿元。在网采订单总金额中，医保目录内药品网采订单金额为9225亿元，占全部网采订单的92.6%。 八、价格监测和信用评价取得新进展 组织开展“四同”药品（通用名、厂牌、剂型、规格均相同的药品）价格协同治理。 2024年，整理司法等部门公开案源信息1369条，累计通报3批全国医药商业贿赂案源。截至2024年底，各地评定一般失信企业612家、中等失信企业76家、严重失信企业40家、特别严重失信企业7家。 九、医保基金监管保障基金安全 2024年，全国医保系统共追回医保基金275亿元，其中通过协议处理挽回基金损失233.63亿元，查实欺诈骗保机构2008家，移交司法机关1045家、移交纪检监察机关3638家、移交卫生健康等行政部门9734家。联合公安机关侦办医保案件3018起，抓获犯罪嫌疑人10741名，涉案金额24.3亿元。通过智能监管子系统挽回医保基金损失31亿元。 2024年，全国共发放举报奖励754人次，奖励金额186.6万元。 十、医保助力经济社会发展情况 支持“三医”发展。国家医保局成立以来，医保基金支出分别为：2018年支出1.70万亿元，2019年支出2.02万亿元，2020年支出2.10万亿元，2021年支出2.40万亿元，2022年支出2.46万亿元，2023年支出2.82万亿元，2024年支出2.97万亿元，2018年至2024年医保基金累计支出16.48万亿元，年均增速达11%，既为广大人民群众看病就医提供了坚实保障，也为医药行业发展、医药技术进步、产业能力提升提供了有力支持。 深化职工医保门诊共济保障改革。扩大个人账户共济的人员范围和资金使用范围，2024年个人账户共济使用512亿元，促进盘活存量资金，有效减轻参保人就医负担。 “三结算”赋能医疗、医药。医保基金对医疗机构的即时结算，已在170个统筹地区开展，大幅压缩医保基金拨付时限，最短压缩到1个工作日，2025年年底将覆盖80%统筹地区。逐步扩大医保基金对医药企业的直接结算，目前已超过10个省份开展了医保基金对集采中选企业的直接结算，企业的货款结算周期从原来的至少6个月缩减为交货验收合格后次月底前，2025年年底将基本推开。谋划推进同步结算，研究医保数据赋能商业保险公司、医保基金与商业保险同步结算以及其他有关支持政策。 支持医药创新。建立了以新药为主体的医保准入和谈判续约机制，创新药从上市到纳入医保的时间大大缩短，2018年至2024年，医保谈判新增药品协议期内销售额超过5400亿元，其中医保基金支出超过3700亿元。 注：本快报中部分数据因四舍五入，总计与分项合计略有差异。 [1]该部分数据为初步统计数据。 中国医保，一生守护！维护医保基金安全，人人有责！打击欺诈骗保举报电话：010-89061396，010-89061397；邮箱：jubao@nhsa.gov.cn。
In 2024, the National Healthcare Security Administration (NHSA) adhered to the guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, thoroughly studied and implemented the spirit of the 20th National Congress of the Communist Party of China (CPC) and the Second and Third Plenary Sessions of the 20th Central Committee of the CPC, fully implemented the deployment of the Central Economic Work Conference, and followed the decision-making arrangements of the Central Committee of the CPC and the State Council. It sought progress while maintaining stability, deepened reform, translated the outcomes of the theme education on studying and implementing Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era and Party discipline education into tangible benefits for the people in medical insurance reform and development, and promoted the medical security cause to enter a new journey. I. Steady Operation of Basic Medical Insurance (1) Participant Status As of the end of 2024, the number of basic medical insurance participants reached 1,326.3783 million. The quality of participation continued to improve, the participation structure was further optimized, and the participation rate remained stable at 95%. (2) Fund Revenue and Expenditure In 2024, the total revenue and total expenditure of basic medical insurance funds (including maternity insurance) were 348.0995 billion yuan and 296.7592 billion yuan, respectively. The revenue of employee basic medical insurance funds (including maternity insurance) was 236.7159 billion yuan, of which the overall planning fund revenue was 173.6893 billion yuan; the fund expenditure was 190.5655 billion yuan, of which the overall planning fund expenditure was 132.0504 billion yuan. The revenue of urban and rural resident basic medical insurance funds was 111.3836 billion yuan, with expenditure of 106.1938 billion yuan. (3) Benefit Enjoyment [1] In 2024, the total person-times of outpatient benefits enjoyed were 6.689 billion, a year-on-year growth of 37.44%. Among them, employees enjoyed 3.529 billion person-times of outpatient benefits, a year-on-year growth of 43.82%, and residents enjoyed 3.160 billion person-times of outpatient benefits, a year-on-year growth of 30.95%. The total person-times of inpatient benefits enjoyed were 291.8226 million, a year-on-year growth of 4.48%, among which employees enjoyed 86.5223 million person-times of inpatient benefits, a year-on-year growth of 8.03%, and residents enjoyed 205.3003 million person-times of inpatient benefits, a year-on-year growth of 3.05%. The average per-capita hospitalization expense was 8,443.63 yuan, with 11,169.11 yuan for employees and 7,295.00 yuan for residents. II. Maternity Insurance Helps Reduce Childbirth Costs As of the end of 2024, the number of maternity insurance participants reached 252.9751 million, an increase of 3.9045 million year-on-year. The benefit expenditure of maternity insurance funds was 143.178 billion yuan, an increase of 36.268 billion yuan over the previous year, with a growth rate of 33.92%. III. Remarkable Achievements in Medical Insurance Supporting Rural Revitalization In 2024, 86.228 million people in the 25 provinces that originally undertook the task of poverty alleviation through medical insurance received participation subsidies. Among them, 71.909 million people were subsidized for participation through medical assistance channels, 15.897 million people were subsidized through other channels in the current year, and approximately 1.577 million people enjoyed subsidies through both channels. The total expenditure on participation subsidies was 17.51 billion yuan, of which the cumulative expenditure of medical assistance in the current year was 14.63 billion yuan, and the cumulative expenditure of other channels in the current year was 2.88 billion yuan. The participation rate of rural low-income population and people lifted out of poverty remained above 99%. The triple medical security system including basic medical insurance, serious illness insurance and medical assistance accumulatively benefited 218.317 million person-times of rural low-income population for medical treatment, reducing their medical expenses by 196.161 billion yuan. IV. Direct Settlement of Off-site Medical Care Facilitates People's Life and Work As of the end of 2024, there were 644,000 inter-provincial online designated medical institutions and pharmacies, including 230,300 inter-provincial online designated medical institutions and 413,700 inter-provincial online designated retail pharmacies. In 2024, the national inter-provincial direct settlement of inpatient expenses covered 14.3356 million person-times, with fund payment of 158.673 billion yuan, representing a 27.37% year-on-year growth in settlement person-times and a 17.43% year-on-year growth in fund payment. The national inter-provincial direct settlement of outpatient expenses (including general outpatient, chronic and special outpatient diseases and pharmacy drug purchases) covered 224 million person-times, with fund payment of 36.051 billion yuan, representing a 90.18% year-on-year growth in settlement person-times and a 94.36% year-on-year growth in fund payment. V. Expansion of Medical Insurance Drug Catalog Benefits More Patients The National Drug Catalog for Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance (2024) contains 3,159 kinds of western and traditional Chinese patent medicines, including 1,765 western medicines and 1,394 traditional Chinese patent medicines, plus 892 kinds of traditional Chinese herbal pieces. Since the establishment of the NHSA in 2018, it has carried out dynamic adjustments to the medical insurance drug catalog for 7 consecutive years, with a total of 835 new drugs added to the catalog, including 91 new drugs added in 2024. In 2024, 397 negotiated drugs within the agreement period were reimbursed for 280 million person-times. VI. Payment Method Reform Reduces Patients' Medical Burden As of the end of 2024, per-case payment covered all coordination areas across the country, and the medical insurance fund expenditure for per-case payment accounted for more than 80% of the inpatient medical insurance fund expenditure in the coordination areas. 116 coordination areas have launched the version 2.0 grouping scheme for per-case payment, more than 90% of coordination areas have established special case negotiation mechanisms, and all coordination areas have established medical insurance data working groups. VII. Price Reform and Bidding Procurement Promote "Three Medical" Collaborative Development The "three medical sectors" refer to medical care, pharmaceuticals and medical insurance. We have normalized the dynamic adjustment mechanism of medical service prices, all provinces have carried out price adjustment assessments, 11 provinces have launched dynamic price adjustments, 5 provinces have launched special price adjustments, and released 20 batches of project establishment guidelines. We have progressively carried out risk disposal for 6 batches of drugs and 3 batches of medical consumables, effectively resolving a number of abnormal price issues caused by fictitious costs, artificial shortages driving price hikes, monopoly and sales control, etc. We carried out the 10th national centralized drug procurement, covering 62 varieties; carried out the 5th national centralized procurement of high-value medical consumables, including 2 categories: cochlear implants and peripheral vascular stents. We also guided Shandong Province to lead the national centralized procurement of traditional Chinese herbal pieces, covering 45 varieties, and guided Hubei Province to lead the national centralized procurement of traditional Chinese patent medicines, covering 175 varieties. As of the end of 2024, the number of nationally and provincially centralized procurement drug varieties in each province has reached more than 500, completing the 14th Five-Year Plan target ahead of schedule. In 2024, the total amount of online procurement orders through provincial pharmaceutical centralized procurement platforms across the country was 996.2 billion yuan, including 790.2 billion yuan for western medicines (chemical drugs and biological products) and 206 billion yuan for traditional Chinese patent medicines. Among the total online procurement orders, the online procurement amount of drugs in the medical insurance catalog was 922.5 billion yuan, accounting for 92.6% of all online procurement orders. VIII. New Progress in Price Monitoring and Credit Evaluation We organized collaborative price governance for "four-same" drugs (drugs with the same generic name, brand, dosage form and specification). In 2024, 1,369 pieces of case source information publicly released by judicial and other departments were sorted out, and 3 batches of national pharmaceutical commercial bribery case sources were cumulatively released. As of the end of 2024, various regions have assessed 612 general dishonest enterprises, 76 medium dishonest enterprises, 40 seriously dishonest enterprises and 7 extremely seriously dishonest enterprises. IX. Medical Insurance Fund Supervision Ensures Fund Safety In 2024, the national medical insurance system recovered a total of 27.5 billion yuan of medical insurance funds, of which 23.363 billion yuan was recovered through agreement processing, 2,008 institutions involved in insurance fraud were verified, 1,045 were transferred to judicial organs, 3,638 to discipline inspection and supervision organs, and 9,734 to health and other administrative departments. It jointly handled 3,018 medical insurance cases with public security organs, arrested 10,741 criminal suspects, with an involved amount of 2.43 billion yuan. 3.1 billion yuan of medical insurance fund losses were recovered through the intelligent supervision subsystem. In 2024, a total of 754 person-times received report rewards nationwide, with a total reward amount of 1.866 million yuan. X. Medical Insurance's Contribution to Economic and Social Development We support the development of the three medical sectors. Since the establishment of the NHSA, the expenditure of medical insurance funds has been as follows: 170 billion yuan in 2018, 202 billion yuan in 2019, 210 billion yuan in 2020, 240 billion yuan in 2021, 246 billion yuan in 2022, 282 billion yuan in 2023, and 297 billion yuan in 2024. The cumulative expenditure of medical insurance funds from 2018 to 2024 was 1,648 billion yuan, with an average annual growth rate of 11%. This has not only provided a solid guarantee for the medical treatment of the people, but also strongly supported the development of the pharmaceutical industry, the progress of pharmaceutical technology and the improvement of industrial capabilities. We deepened the employee medical insurance outpatient mutual aid security reform, expanding the scope of personnel and fund use scope of individual account mutual aid. In 2024, the mutual aid use of individual accounts was 51.2 billion yuan, promoting the revitalization of stock funds and effectively reducing the medical burden of participants. The "Three Settlements" empower medical care and pharmaceuticals. Immediate settlement of medical insurance funds to medical institutions has been carried out in 170 coordination areas, greatly shortening the disbursement time limit of medical insurance funds, with the shortest being reduced to 1 working day, and it will cover 80% of coordination areas by the end of 2025. We gradually expand the direct settlement of medical insurance funds to pharmaceutical enterprises. Currently, more than 10 provinces have carried out direct settlement of medical insurance funds to enterprises selected in centralized procurement, reducing the payment settlement cycle of enterprises from the original at least 6 months to before the end of the next month after delivery and acceptance, and it will be basically fully implemented by the end of 2025. We plan and promote synchronous settlement, studying policies to empower commercial insurance companies with medical insurance data, synchronous settlement of medical insurance funds and commercial insurance, and other relevant supporting policies. We support pharmaceutical innovation. A medical insurance access and negotiation renewal mechanism centered on new drugs has been established, and the time from launch of innovative drugs to inclusion in medical insurance has been greatly shortened. From 2018 to 2024, the sales of newly added drugs in medical insurance negotiations within the agreement period exceeded 540 billion yuan, of which medical insurance fund expenditure exceeded 370 billion yuan. Note: Some data in this bulletin have rounding differences, so the total and the sum of sub-items may slightly differ. [1] The data in this section are preliminary statistical data. China Healthcare Security, Protecting You for Life! Everyone is responsible for safeguarding the safety of medical insurance funds! Report hotline for medical insurance fraud crackdown: 010-89061396, 010-89061397; Email: jubao@nhsa.gov.cn
