2023年全国医疗保障事业发展统计公报

2023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精神，坚决贯彻落实党中央、国务院决策部署，完整、准确、全面贯彻新发展理念，加快构建新发展格局，持续完善中国特色医疗保障制度，实现管理服务提质增效，医保制度运行总体平稳，群众待遇巩固完善，基金运行安全可持续。 一、基本医疗保险运行安全稳健 截至2023年底，全国基本医疗保险（以下简称基本医保）参保133389万人。2023年，全国基本医疗保险（含生育保险）基金总收入33501.36亿元，全国基本医疗保险（含生育保险）基金总支出28208.38亿元，2023年统筹基金当期结存5039.59亿元，累计结存33979.75亿元。 （一）职工基本医疗保险 1.参保人数。截至2023年底，职工医保参保37095万人，比上年增加852万人，增长2.3%，其中，在职职工27099万人，比上年增长1.9%；退休职工9996万人，比上年增长3.7%，在职退休比为2.71。 2019-2023年职工医保参保人员结构 单位：万人 企业、机关事业、灵活就业等其他人员参保人数（包括在职职工和退休人员）分别为24367万人、6668万人、6060万人。职工医保统账结合和单建统筹参保人数分别为34525万人、2569万人。 2.基金收支。2023年，职工医保基金（含生育保险）收入22931.65亿元，比上年增长10.3%。基金（含生育保险）支出17750.73亿元，比上年增长16.4%。2023年，职工医保统筹基金（含生育保险）收入16580.30亿元，比上年增长26.0%；统筹基金（含生育保险）支出11652.77亿元，比上年增长21.9%；统筹基金（含生育保险）当期结存4927.53 亿元，累计结存（含生育保险）26316.05亿元。2023年，职工医保个人账户收入6351.35亿元，个人账户支出6097.95亿元，个人账户当期结存253.39亿元，累计结存13954.21亿元。 3.待遇享受。2023年职工参保人员待遇享受人次较快增长，达25.3亿人次，比上年增长20.2%。其中，普通门急诊21.8亿人次，门诊慢特病2.7亿人次，住院0.8亿人次。此外，享受药店购药23亿人次。 2019-2023年职工医保享受待遇人次 单位：亿人次 2023年，职工医保参保人员住院率21.86%。其中，在职职工住院率为11.93%，退休人员住院率为49.02%。次均住院费用为12175元，其中，在三级、二级、一级及以下医疗机构（含未定级）的次均住院费用分别为14586元、8665元、6310元。次均住院床日9.8天。 2019-2023年职工医保次均住院费用和住院人次 单位：元、万人次 2023年职工医保参保人员医药总费用19879.79亿元，比上年增长21.3%，其中，在医疗机构发生17408.48亿元，在药店发生2471.31亿元。医疗机构发生费用中，在职职工医疗费用7501.76亿元，退休人员医疗费用9906.71亿元。 职工医保住院费用目录内基金支付比例84.6%，三级、二级、一级及以下医疗机构支付比例分别为83.5%、87.4%、89.4%。 （二）城乡居民基本医疗保险 1.参保人数。截至2023年底，城乡居民基本医疗保险（以下简称居民医保）参保96294万人。 2.基金收支。2023年，居民医保基金收入10569.71亿元，支出10457.65亿元，当期结存112.06亿元，累计结存7663.70亿元。 2019-2023年居民医保基金收支情况 单位：亿元 3.待遇享受。2023年，参加居民医保人员享受待遇26.1亿人次，比上年增长21.1%。其中，普通门急诊20.8亿人次，门诊慢特病3.4亿人次，住院2亿人次。次均住院费用7674元，其中，在三级、二级、一级及以下医疗机构（含未定级）的次均住院费用分别为12765元、6205元、2943元。居民医保参保人员住院率为20.7%，次均住院床日8.8天。 2019-2023年居民医保享受待遇人次 单位：亿人次 2023年，居民医保参保人员医药费用19581.56亿元，其中，在医疗机构费用19426.97亿元，在药店购药费用154.59亿元。比上年增长19.4%。居民医保住院费用目录内基金支付比例68.1%，三级、二级、一级及以下医疗机构支付比例分别为63.2%、72.4%、80.8%。 2019-2023年居民医保次均住院费用和住院人次 单位：元、万人次 二、生育保险制度保障功能持续发挥 2023年，全国参加生育保险24903万人，比上年增加282万人。从2023年起，进一步规范统一生育保险待遇享受统计口径，将产前检查、计划生育人次纳入生育保险待遇统计，享受各项生育保险待遇2834万人次，比上年增加1065万人次，比上年增长60.2%。生育保险基金支出1177.23亿元。 2019-2023年参加生育保险人数和待遇享受人次 单位：万人、万人次 三、医疗救助托底功能持续增强 2023年，全国医疗救助支出746亿元，医疗救助基金资助8020万人[1]参加基本医疗保险，实施门诊和住院救助15340万人次，全国次均住院救助、门诊救助分别为1241元、132元。2023年，中央财政安排医疗救助补助资金297亿元。 全国纳入监测范围农村低收入人口参保率稳定在99%以上。各项医保综合帮扶政策惠及农村低收入人口就医1.86亿人次，减轻农村低收入人口医疗费用负担1883.5亿元。 [1]不含其他部门资助参保人数。 2019-2023年医疗救助支出和资助人数 单位：亿元、万人 四、“三医”协同发展和治理成效显著 （一）医保药品目录 《国家基本医疗保险、工伤保险和生育保险药品目录（2023年）》收载西药和中成药共3088种，其中，西药1698种，中成药1390种，另目录含中药饮片892种。2023年调整中新纳入药品126种。 2019-2023年版国家医保药品目录收载的西药和中成药 单位：种 自2018年国家医保局成立以来，连续6年开展医保药品目录动态调整，累计744种药品新增进入目录范围。2023年，协议期内谈判药品报销2.4亿人次，通过谈判降价和医保报销，当年累计为患者减负近2300亿元。 （二）医保支付方式改革 截至2023年底，全国384个统筹地区开展了按病组和病种分值（DRG/DIP）付费，其中，开展DRG付费的城市190个，开展DIP付费的城市192个，天津、上海两个直辖市DRG和DIP并行付费。 （三）药品耗材集中采购 2023年，开展第八批、第九批国家组织药品集采，涉及80种药品，平均降价57%。开展第四批国家组织人工晶体及运动医学类耗材集采，平均降价70%。截至目前，共开展九批国家组织药品集采，覆盖374种药品，开展四批国家组织高值医用耗材集采，覆盖冠脉支架、人工关节、骨科脊柱类耗材、人工晶体和运动医学类耗材等大类。 （四）医药价格治理 2023年，启动挂网药品价格治理，开展统一挂网药品价格数据信息规范工作。监测国家短缺药品清单和国家临床必需易短缺药品重点监测清单药品价格和配送情况，提取256条异常高价和182条异常配送信息，督促企业主动纠正异常高价275次。强化药品价格常态化管理监督，约谈相关医药企业23家，涉及30个品种，约谈药品平均降价超40%。有序推进医疗服务价格改革试点，指导5个试点城市开展首轮调价。稳步加快医疗服务价格动态调整，指导28个具备条件的省份开展调价工作。指导各省医保局加快审核新增医疗服务价格项目，全年各省新增医疗服务价格项目合计达到1900余项。 五、异地就医就诊人次持续增加 2023年，全国普通门急诊、门诊慢特病及住院异地就医2.43亿人次，其中，职工医保异地就医1.61亿人次（包括省内异地就医1.01亿人次，省外异地就医0.6亿人次），居民医保异地就医8214.36万人次（包括省内异地就医5196.78万人次，省外异地就医 3017.58万人次）。全国普通门急诊、门诊慢特病及住院异地就医费用7111.05亿元，其中，职工医保异地就医费用2806.51亿元，居民医保异地就医费用4304.54亿元。 2019-2023年全国异地就医人次和就医费用 单位：万人次、亿元 六、医保基金监管更加有力 2023年，全国医保系统共检查定点医药机构80.2万家，处理违法违规机构45.1万家，其中，解除医保服务协议4176家，行政处罚20586家，移交司法机关367家；处理违法违规人员32690人，其中，暂停医疗费用联网结算4883人，移交司法机关1399人。2023年，追回医保基金186.5亿元。2023年，国家医保局组织飞行检查34组次，检查定点医疗机构66家、医保经办机构32家，查出涉嫌违法违规资金9.2亿元。 在被检查医药机构中通过协议处理拒付及追回资金134.07亿元，收取违约金14.47亿元。拒付或追回资金涉及定点医药机构19.87万家。 七、长期护理保险试点稳步推进 2023年，49个试点城市参加长期护理保险人数共18330.87万人，享受待遇人数134.29万人。2023年基金收入243.63亿元，基金支出118.56亿元。长期护理保险定点服务机构8080家，护理服务人员30.28万人。 2020-2023年参加长期护理保险人数和享受待遇人数 单位：万人 2020-2023年长期护理保险基金收支情况 单位：亿元 说明：本公报中部分数据因四舍五入，总计与分项合计略有差异。

National Healthcare Security Administration (NHSA) adhered to the guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era in 2023, thoroughly studied and implemented the spirit of the 20th National Congress of the Communist Party of China, resolutely implemented the decision-making and deployment of the Central Committee of the Communist Party of China and the State Council, fully, accurately and comprehensively applied the new development philosophy, accelerated the building of a new development paradigm, continuously improved the medical security system with Chinese characteristics, achieved improved quality and efficiency of management and services, maintained overall stable operation of the medical insurance system, consolidated and improved benefits for the people, and ensured safe and sustainable operation of medical insurance funds.

I. Steady and Safe Operation of Basic Medical Insurance
As of the end of 2023, the number of people covered by the national basic medical insurance (hereinafter referred to as basic medical insurance) reached 1,333.89 million. In 2023, the total revenue of the national basic medical insurance (including maternity insurance) funds was 3,350.136 billion yuan, and the total expenditure was 2,820.838 billion yuan. The current balance of the pooling fund in 2023 was 503.959 billion yuan, with a cumulative balance of 3,397.975 billion yuan.

(1) Employee Basic Medical Insurance
1. Number of Participants
As of the end of 2023, 370.95 million people were covered by employee basic medical insurance, an increase of 8.52 million or 2.3% year-on-year. Among them, 270.99 million were on-the-job employees, up 1.9% year-on-year; 99.96 million were retired employees, up 3.7% year-on-year, with the ratio of on-the-job to retired employees standing at 2.71.

Structure of Employee Basic Medical Insurance Participants, 2019-2023
Unit: 10,000 persons
The number of participants from enterprises, government and public institutions, flexible employment and other groups (including on-the-job employees and retired employees) were 243.67 million, 66.68 million and 60.60 million respectively. The number of participants in the combined pooling and individual account system and the individual-only pooling system of employee basic medical insurance were 345.25 million and 25.69 million respectively.

2. Fund Revenue and Expenditure
In 2023, the revenue of employee basic medical insurance funds (including maternity insurance) was 2,293.165 billion yuan, up 10.3% year-on-year. The expenditure was 1,775.073 billion yuan, up 16.4% year-on-year. In 2023, the revenue of the employee basic medical insurance pooling fund (including maternity insurance) was 1,658.030 billion yuan, up 26.0% year-on-year; the expenditure was 1,165.277 billion yuan, up 21.9% year-on-year; the current balance of the pooling fund (including maternity insurance) was 492.753 billion yuan, with a cumulative balance (including maternity insurance) of 2,631.605 billion yuan. In 2023, the revenue of individual accounts of employee basic medical insurance was 635.135 billion yuan, the expenditure was 609.795 billion yuan, the current balance of individual accounts was 25.339 billion yuan, with a cumulative balance of 1,395.421 billion yuan.

3. Benefit Enjoyment
In 2023, the number of benefit enjoyment visits by employee basic medical insurance participants grew rapidly, reaching 2.53 billion visits, up 20.2% year-on-year. Among them, there were 2.18 billion general outpatient and emergency visits, 270 million outpatient visits for chronic and special diseases, and 80 million inpatient visits. In addition, there were 2.3 billion pharmacy purchase visits.

Benefit Enjoyment Visits of Employee Basic Medical Insurance, 2019-2023
Unit: 100 million visits
In 2023, the hospitalization rate of employee basic medical insurance participants was 21.86%. Among them, the hospitalization rate of on-the-job employees was 11.93%, and that of retired employees was 49.02%. The average inpatient cost per visit was 12,175 yuan, with the average inpatient cost per visit in tertiary, secondary, and primary and lower-level medical institutions (including unrated ones) being 14,586 yuan, 8,665 yuan and 6,310 yuan respectively. The average length of inpatient stay was 9.8 days.

Average Inpatient Cost per Visit and Inpatient Visits of Employee Basic Medical Insurance, 2019-2023
Unit: yuan, 10,000 person-times
In 2023, the total medical expenses of employee basic medical insurance participants reached 1,987.979 billion yuan, up 21.3% year-on-year. Among them, 1,740.848 billion yuan was incurred in medical institutions, and 247.131 billion yuan was incurred in pharmacies. Among the expenses incurred in medical institutions, the medical expenses of on-the-job employees were 750.176 billion yuan, and those of retired employees were 990.671 billion yuan.

The fund payment ratio for inpatient expenses within the medical insurance catalog of employee basic medical insurance was 84.6%, with the payment ratios in tertiary, secondary, and primary and lower-level medical institutions being 83.5%, 87.4% and 89.4% respectively.

(2) Urban and Rural Resident Basic Medical Insurance
1. Number of Participants
As of the end of 2023, 962.94 million people were covered by urban and rural resident basic medical insurance (hereinafter referred to as resident medical insurance).

2. Fund Revenue and Expenditure
In 2023, the revenue of resident medical insurance funds was 1,056.971 billion yuan, the expenditure was 1,045.765 billion yuan, the current balance was 11.206 billion yuan, with a cumulative balance of 766.370 billion yuan.

Fund Revenue and Expenditure of Resident Medical Insurance, 2019-2023
Unit: 100 million yuan
3. Benefit Enjoyment
In 2023, the number of benefit enjoyment visits by urban and rural resident medical insurance participants reached 2.61 billion visits, up 21.1% year-on-year. Among them, there were 2.08 billion general outpatient and emergency visits, 340 million outpatient visits for chronic and special diseases, and 200 million inpatient visits. The average inpatient cost per visit was 7,674 yuan, with the average inpatient cost per visit in tertiary, secondary, and primary and lower-level medical institutions (including unrated ones) being 12,765 yuan, 6,205 yuan and 2,943 yuan respectively. The hospitalization rate of resident medical insurance participants was 20.7%, and the average length of inpatient stay was 8.8 days.

Benefit Enjoyment Visits of Resident Medical Insurance, 2019-2023
Unit: 100 million visits
In 2023, the total medical expenses of urban and rural resident medical insurance participants reached 1,958.156 billion yuan, with 1,942.697 billion yuan incurred in medical institutions and 15.459 billion yuan incurred in pharmacy purchases, up 19.4% year-on-year. The fund payment ratio for inpatient expenses within the medical insurance catalog of resident medical insurance was 68.1%, with the payment ratios in tertiary, secondary, and primary and lower-level medical institutions being 63.2%, 72.4% and 80.8% respectively.

Average Inpatient Cost per Visit and Inpatient Visits of Resident Medical Insurance, 2019-2023
Unit: yuan, 10,000 person-times

II. Continuous Improvement of the Guarantee Function of Maternity Insurance System
In 2023, 249.03 million people participated in maternity insurance nationwide, an increase of 2.82 million year-on-year. Starting from 2023, the statistical caliber of maternity insurance benefit enjoyment has been further standardized and unified, including prenatal check-up and family planning visits into the maternity insurance benefit statistics. The number of visits enjoying various maternity insurance benefits reached 28.34 million, an increase of 10.65 million or 60.2% year-on-year. The expenditure of maternity insurance funds was 117.723 billion yuan.

Number of Maternity Insurance Participants and Benefit Enjoyment Visits, 2019-2023
Unit: 10,000 persons, 10,000 person-times

III. Continuous Enhancement of the Bottom-line Guarantee Function of Medical Assistance
In 2023, the national medical assistance expenditure reached 74.6 billion yuan. The medical assistance fund subsidized 80.20 million people[1] to participate in basic medical insurance, and provided outpatient and inpatient medical assistance for 153.40 million person-times. The average per-visit assistance for inpatient and outpatient medical assistance nationwide was 1,241 yuan and 132 yuan respectively. In 2023, the central government allocated 29.7 billion yuan of medical assistance subsidies.

The participation rate of rural low-income populations included in the monitoring range in basic medical insurance has remained stable at over 99%. Various comprehensive medical insurance support policies benefited 186 million visits of rural low-income populations for medical treatment, reducing their medical expense burden by 188.35 billion yuan.

[1] Excluding the number of people subsidized to participate in insurance by other departments.

Medical Assistance Expenditure and Subsidized Participants, 2019-2023
Unit: 100 million yuan, 10,000 persons

IV. Remarkable Achievements in the Coordinated Development and Governance of "Three Medical Fields" (Medical Care, Medical Insurance, and Pharmaceutical Supply)
(1) Medical Insurance Drug Catalog
The National Drug Catalog for Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance (2023) includes 3,088 kinds of western medicines and proprietary Chinese medicines, among which 1,698 are western medicines and 1,390 are proprietary Chinese medicines. In addition, the catalog includes 892 kinds of Chinese herbal pieces. A total of 126 drugs were newly added in the 2023 adjustment.

Western Medicines and Proprietary Chinese Medicines Included in the National Medical Insurance Drug Catalog, 2019-2023 Editions
Unit: species
Since the establishment of the National Healthcare Security Administration in 2018, dynamic adjustments to the medical insurance drug catalog have been carried out for 6 consecutive years, with a total of 744 drugs added to the catalog. In 2023, negotiated drugs within the agreement period were reimbursed for 240 million visits. Through negotiated price reductions and medical insurance reimbursement, a total of nearly 230 billion yuan was saved for patients in that year.

(2) Medical Insurance Payment Method Reform
As of the end of 2023, 384 pooling regions across the country have implemented diagnosis-related group (DRG) and diagnosis-interval packet (DIP) payment methods. Among them, 190 cities have carried out DRG payment, 192 cities have carried out DIP payment, and the two municipalities directly under the Central Government, Tianjin and Shanghai, have implemented parallel DRG and DIP payment.

(3) Centralized Procurement of Drugs and Medical Consumables
In 2023, the 8th and 9th batches of national organized drug centralized procurement were carried out, covering 80 drugs with an average price reduction of 57%. The 4th batch of national organized centralized procurement of artificial crystals and sports medicine consumables was carried out, with an average price reduction of 70%. Up to now, a total of 9 batches of national organized drug centralized procurement have been carried out, covering 374 drugs, and 4 batches of national organized high-value medical consumables centralized procurement have been carried out, covering major categories such as coronary stents, artificial joints, orthopedic spinal consumables, artificial crystals and sports medicine consumables.

(4) Pharmaceutical and Medical Price Governance
In 2023, the governance of drug prices on the online trading platform was launched, and the standardization of unified online drug price data and information was carried out. The prices and distribution of drugs listed in the National Shortage Drugs List and the National Key Monitoring List of Clinically Necessary Easy-to-be-Shortage Drugs were monitored, with 256 abnormal high-price records and 182 abnormal distribution records extracted, and enterprises were urged to voluntarily correct abnormal high prices 275 times. The daily management and supervision of drug prices were strengthened, and 23 relevant pharmaceutical enterprises involving 30 drug varieties were interviewed. The average price reduction of the interviewed drugs exceeded 40%. The pilot reform of medical service prices was carried out in an orderly manner, and 5 pilot cities were guided to carry out the first round of price adjustment. The dynamic adjustment of medical service prices was steadily accelerated, and 28 eligible provinces were guided to carry out price adjustment work. Provincial healthcare security administrations were guided to accelerate the review of newly added medical service price items, with a total of more than 1,900 newly added medical service price items across the country in the whole year.

V. Continuous Growth of Cross-region Medical Visits
In 2023, there were 243 million cross-region medical visits for general outpatient and emergency, outpatient chronic and special diseases and inpatient care across the country. Among them, 161 million cross-region medical visits were made by employee basic medical insurance participants (including 101 million intra-provincial cross-region visits and 60 million inter-provincial cross-region visits), and 82.1436 million cross-region medical visits were made by resident basic medical insurance participants (including 51.9678 million intra-provincial cross-region visits and 30.1758 million inter-provincial cross-region visits). The total cost of cross-region medical visits for general outpatient and emergency, outpatient chronic and special diseases and inpatient care reached 711.105 billion yuan, among which 280.651 billion yuan was incurred by employee basic medical insurance and 430.454 billion yuan was incurred by resident basic medical insurance.

Cross-region Medical Visits and Costs Across the Country, 2019-2023
Unit: 10,000 person-times, 100 million yuan

VI. Strengthened Supervision of Medical Insurance Funds
In 2023, the national medical insurance system inspected a total of 802,000 designated medical and pharmaceutical institutions, and dealt with 451,000 violating institutions. Among them, 4,176 institutions had their medical insurance service agreements terminated, 20,586 institutions were subject to administrative penalties, and 367 institutions were transferred to judicial organs. A total of 32,690 violating personnel were dealt with, among whom 4,883 people had their medical expense online settlement suspended, and 1,399 people were transferred to judicial organs. In 2023, 18.65 billion yuan of medical insurance funds were recovered. In 2023, the National Healthcare Security Administration organized 34 rounds of unannounced inspections, inspecting 66 designated medical institutions and 32 medical insurance handling institutions, and detected 920 million yuan of suspected violating funds. Among the inspected medical and pharmaceutical institutions, 13.407 billion yuan of funds were deducted or recovered through agreement processing, and 1.447 billion yuan of liquidated damages were collected. The deducted or recovered funds involved 198,700 designated medical and pharmaceutical institutions.

VII. Steady Progress of Long-term Care Insurance Pilot Program
In 2023, a total of 183.3087 million people participated in the long-term care insurance in 49 pilot cities, with 1.3429 million people enjoying benefits. In 2023, the revenue of long-term care insurance funds was 24.363 billion yuan, and the expenditure was 11.856 billion yuan. There were 8,080 designated service institutions for long-term care insurance, and 302,800 nursing service personnel.

Participants and Benefit Enjoyers of Long-term Care Insurance, 2020-2023
Unit: 10,000 persons
Fund Revenue and Expenditure of Long-term Care Insurance, 2020-2023
Unit: 100 million yuan

Note: Some data in this bulletin are rounded, so there may be slight differences between the total and the sum of individual items.