2024年全国医疗保障事业发展统计公报

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，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，推动群众待遇巩固提升，基金运行安全稳健，管理服务提质增效。 一、基本医疗保险运行安全稳健 截至2024年底，全国基本医疗保险（以下简称基本医保）参保132662.08万人，参保率巩固在95%。2024年全国基本医疗保险（含生育保险）基金总收入34913.37亿元，基金总支出29764.03亿元。统筹基金当期结存4639.17亿元，累计结存38628.52亿元。 （一）职工基本医疗保险 1.参保人数。截至2024年底，职工医保参保37948.34万人，比上年增加853.70万人，增长2.3%。其中在职职工27490.84万人，退休职工10457.50万人。 2020-2024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的参保人数分别为24535.36万人、6797.07万人、6615.91万人。职工医保统账结合和单建统筹参保人员分别为35435.02万人、2513.32万人。 2.基金收支。2024年职工医保基金（含生育保险）收入23732.47亿元，比上年增长3.5%；基金（含生育保险）支出19102.54亿元，比上年增长7.6%。2024年职工医保统筹基金（含生育保险）收入17342.45亿元，比上年增长4.6%；统筹基金（含生育保险）支出13222.71亿元，比上年增长13.5%；统筹基金（含生育保险）当期结存4119.75亿元，累计结存30445.50亿元。2024年职工医保个人账户收入6390.01亿元，个人账户支出5879.83亿元，个人账户当期结存510.18亿元，累计结存14471.75亿元。 2020-2024年职工医保基金收支情况 单位：亿元 3.待遇享受。2024年职工参保人员待遇享受人次为53.08亿人次，比上年增长9.9%。其中普通门急诊26.33亿人次，门诊慢特病3.22亿人次，住院0.82亿人次，享受药店购药22.72亿人次。 2020-2024年职工医保享受待遇人次（不含药店购药） 单位：亿人次 2024年职工医保参保人员次均住院费用为11707元，其中三级、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13840元、8327元、6105元。次均住院床日8.7天，其中三级、二级、一级及以下医疗机构（含未定级）次均住院床日为7.7天，9.6天，12.6天。 2020-2024年职工医保次均住院费用和出院人次 单位：元、万人次 2024年职工医保参保人员医药总费用20587.46亿元，比上年增长3.6%，其中医疗机构费用18366.57亿元，药店费用2220.89亿元。医疗机构发生费用中，在职职工医疗费用8108.22亿元，退休人员医疗费用10258.35亿元。 职工医保住院费用目录内基金支付比例84.8%，三级、二级、一级及以下医疗机构支付比例分别为83.8%、87.6%、89.9%。 （二）城乡居民基本医疗保险 1.参保人数。截至2024年底，城乡居民基本医疗保险（以下简称居民医保）参保94713.73万人。 2.基金收支。2024年居民医保基金收入11180.91亿元，支出10661.49亿元，当期结存519.42亿元，累计结存8183.02亿元。 2020-2024年居民医保基金收支情况 单位：亿元 3.待遇享受。2024年参加居民医保人员享受待遇30.35亿人次，比上年增长14.9%。其中普通门急诊23.78亿人次，门诊慢特病4.16亿人次，住院2.06亿人次，药店购药0.35亿人次。 2020-2024年居民医保享受待遇人次（不含药店购药） 单位：亿人次 2024年居民医保次均住院费用7408元，其中三级、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11956元、5852元、2730元。居民医保参保人员次均住院床日8.5天，其中三级、二级、一级及以下医疗机构（含未定级）的次均住院床日分别为7.7天、9.5天、8.2天。 2020-2024年居民医保次均住院费用和出院人次 单位：元、万人次 2024年居民医保参保人员医药费用20312.16亿元，比上年增长3.7%，其中医疗机构费用20098.31亿元，药店购药费用213.84亿元。居民医保住院费用目录内基金支付比例68.6%，三级、二级、一级及以下医疗机构支付比例分别为64.1%、73.3%、81.5%。 二、生育保险制度保障功能持续发挥 2024年全国参加生育保险25299.52万人，比上年增加396.38万人，比上年增长1.6%。2024年享受各项生育保险待遇3690.80万人次，比上年增长30.2%；生育保险基金支出1402.93亿元，比上年增长19.2%。截至2024年底，31个省份和新疆生产建设兵团已将辅助生殖纳入医保。 2020-2024年参加生育保险人数和待遇享受人次 单位：万人、万人次 注：从2023年起生育保险待遇享受人次口径增加产前检查人次数 三、医疗救助托底功能持续增强 2024年全国医疗救助支出792.32亿元，医疗救助基金资助7915.67万人[1]参加基本医疗保险，实施门诊和住院救助18090.61万人次，全国次均住院救助、门诊救助分别为1254元、92元。2024年中央财政安排医疗救助补助资金297亿元。 2020-2024年医疗救助支出和资助人数 单位：亿元、万人 [1]医疗救助资助参保人数不含其他部门资助参保人数。 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（2024年）》收载西药和中成药共3159种，其中西药1765种，中成药1394种。2024年新纳入药品91种。 2020-2024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。2024年协议期内谈判药品报销2.8亿人次。 （二）医保支付方式改革 截至2024年底，基本实现按病种付费统筹地区、符合条件的医疗机构全覆盖，按病种付费出院人次占比超过90%，按病种付费的基金占全部符合条件住院医保基金支出比例达到80%左右。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。 （三）药品耗材集中采购 2024年，开展第十批国家组织药品集采，涉及62种药品;开展第五批国家组织高值医用耗材集采，涉及外周血管支架、人工耳蜗2个品种。截至目前，已累计开展10批国家组织药品集采，共纳入435种药品，已累计开展5批国家组织高值医用耗材集采，覆盖心内科、骨科、眼科等领域7大类高值医用耗材。 五、异地就医服务持续优化 2024年全国普通门急诊、门诊慢特病及住院异地就医就诊人次为3.97亿人次，其中职工医保异地就医2.62亿人次，居民医保异地就医1.34亿人次。全国普通门急诊、门诊慢特病及住院异地就医费用7867.74亿元，其中职工医保异地就医费用3184.14 亿元，居民医保异地就医费用4683.61亿元。 2020-2024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 2024年全国医保系统共追回医保基金275亿元，其中通过经办协议处理挽回基金损失233.63亿元，拒付或追回资金涉及定点医药机构28.99万家。查实欺诈骗保机构2008家，联合公安机关侦办医保案件3018起，抓获犯罪嫌疑人10741名。通过智能监管子系统挽回医保基金损失31亿元。全国共发放举报奖励754人次，奖励金额186.6万元。 七、长期护理保险试点稳步推进 2024年，49个试点城市参加长期护理保险人数共18786.34万人，享受待遇人数146.25万人。2024年基金收入279.60亿元，基金支出131.08亿元。长期护理保险定点服务机构8837家，护理服务人员29.28万人。 2020-2024年参加长期护理保险人数和享受待遇人数 单位：万人 2020-2024年长期护理保险基金收支情况 单位：亿元 八、医保持续赋能经济社会发展 （一）赋能“三医”发展 国家医保局成立以来，医保基金累计支出16.57万亿元，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。 2018-2024年医保基金支出情况 单位：万亿元 （二）赋能医药产业创新 建立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。 （三）赋能参保人就医购药 深化职工医保门诊共济改革，扩大个人账户共济的人员范围和资金使用范围，职工医保个人账户家庭共济范围拓宽至近亲属，资金使用逐步实现由省域内共济扩大到跨省共济。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。 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。 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：[phone]；邮箱：[e-mail]。

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 and the second and third plenary sessions of the 20th Central Committee, resolutely implemented the decisions and deployments of the CPC Central Committee and the State Council, fully, accurately and comprehensively applied the new development philosophy, accelerated the building of a new development paradigm, continued to improve the medical security system with Chinese characteristics, promoted the consolidation and improvement of people's benefits, ensured the safe and stable operation of funds, and improved the quality and efficiency of management and services.

1. Safe and Stable Operation of Basic Medical Insurance
As of the end of 2024, the number of people participating in national basic medical insurance (hereinafter referred to as "basic medical insurance") reached 132,662,0800, with the participation rate remaining stable at 95%. In 2024, the total income of the national basic medical insurance (including maternity insurance) fund was 349,133.7 million yuan, and the total expenditure was 297,640.3 million yuan. The current balance of the overall planning fund was 46,391.7 million yuan, and the accumulated balance was 386,285.2 million yuan.

(1) Employee Basic Medical Insurance (EBMI)
1. Number of Participants
As of the end of 2024, 379,483,400 people participated in EBMI, an increase of 8,537,000 people or 2.3% over the previous year. Among them, 274,908,400 were on-the-job employees and 104,575,000 were retired employees.
The number of participants in enterprises, government agencies and institutions, and flexible employment groups were 245,353,600, 67,970,700, and 66,159,100 respectively. The number of EBMI participants under the unified account and individual account system and the individual account-only system were 354,350,200 and 25,133,200 respectively.
Table: Structure of EBMI Participants, 2020-2024 (Unit: 10,000 persons)

2. Fund Income and Expenditure
In 2024, the income of EBMI fund (including maternity insurance) was 237,324.7 million yuan, an increase of 3.5% over the previous year; the expenditure of the fund (including maternity insurance) was 191,025.4 million yuan, an increase of 7.6% over the previous year. In 2024, the income of EBMI overall planning fund (including maternity insurance) was 173,424.5 million yuan, an increase of 4.6% over the previous year; the expenditure of the overall planning fund (including maternity insurance) was 132,227.1 million yuan, an increase of 13.5% over the previous year; the current balance of the overall planning fund (including maternity insurance) was 41,197.5 million yuan, and the accumulated balance was 304,455 million yuan. In 2024, the income of EBMI individual account was 63,900.1 million yuan, the expenditure was 58,798.3 million yuan, the current balance of the individual account was 5,101.8 million yuan, and the accumulated balance was 144,717.5 million yuan.
Table: Income and Expenditure of EBMI Funds, 2020-2024 (Unit: 100 million yuan)

3. Benefit Enjoyment
In 2024, the number of benefit-receiving person-times of EBMI participants was 5.308 billion, an increase of 9.9% over the previous year. Among them, there were 2.633 billion general outpatient and emergency visits, 322 million chronic outpatient special disease visits, 82 million inpatient visits, and 2.272 billion pharmacy purchase visits.
Table: Number of Benefit-Recieving Person-times of EBMI (Excluding Pharmacy Purchases), 2020-2024 (Unit: 100 million person-times)
In 2024, the average per capita hospitalization expense of EBMI participants was 11,707 yuan, and the average per capita hospitalization expenses in tertiary, secondary, and primary and below medical institutions (including unrated institutions) were 13,840 yuan, 8,327 yuan, and 6,105 yuan respectively. The average length of stay per hospitalization was 8.7 days, and the average length of stay in tertiary, secondary, and primary and below medical institutions (including unrated institutions) was 7.7 days, 9.6 days, and 12.6 days respectively.
Table: Average Per Capita Hospitalization Expense and Discharged Person-times of EBMI, 2020-2024 (Unit: yuan, 10,000 person-times)
In 2024, the total medical expenses of EBMI participants were 205,874.6 million yuan, an increase of 3.6% over the previous year, including 183,665.7 million yuan of medical institution expenses and 22,208.9 million yuan of pharmacy expenses. Among the medical institution expenses, the medical expenses of on-the-job employees were 81,082.2 million yuan, and the medical expenses of retirees were 102,583.5 million yuan.
The fund payment ratio within the hospitalization expense catalog of EBMI was 84.8%, and the payment ratios in tertiary, secondary, and primary and below medical institutions were 83.8%, 87.6%, and 89.9% respectively.

(2) Resident Basic Medical Insurance (RBMI)
1. Number of Participants
As of the end of 2024, 947,137,300 people participated in resident basic medical insurance (hereinafter referred to as "resident medical insurance").

2. Fund Income and Expenditure
In 2024, the income of RBMI fund was 111,809.1 million yuan, the expenditure was 106,614.9 million yuan, the current balance was 5,194.2 million yuan, and the accumulated balance was 81,830.2 million yuan.
Table: Income and Expenditure of RBMI Funds, 2020-2024 (Unit: 100 million yuan)

3. Benefit Enjoyment
In 2024, the number of benefit-receiving person-times of RBMI participants was 3.035 billion, an increase of 14.9% over the previous year. Among them, there were 2.378 billion general outpatient and emergency visits, 416 million chronic outpatient special disease visits, 206 million inpatient visits, and 35 million pharmacy purchase visits.
Table: Number of Benefit-Recieving Person-times of RBMI (Excluding Pharmacy Purchases), 2020-2024 (Unit: 100 million person-times)
In 2024, the average per capita hospitalization expense of RBMI participants was 7,408 yuan, and the average per capita hospitalization expenses in tertiary, secondary, and primary and below medical institutions (including unrated institutions) were 11,956 yuan, 5,852 yuan, and 2,730 yuan respectively. The average length of stay per hospitalization was 8.5 days, and the average length of stay in tertiary, secondary, and primary and below medical institutions (including unrated institutions) was 7.7 days, 9.5 days, and 8.2 days respectively.
Table: Average Per Capita Hospitalization Expense and Discharged Person-times of RBMI, 2020-2024 (Unit: yuan, 10,000 person-times)
In 2024, the total medical expenses of RBMI participants were 203,121.6 million yuan, an increase of 3.7% over the previous year, including 200,983.1 million yuan of medical institution expenses and 21,38.4 million yuan of pharmacy purchase expenses. The fund payment ratio within the hospitalization expense catalog of RBMI was 68.6%, and the payment ratios in tertiary, secondary, and primary and below medical institutions were 64.1%, 73.3%, and 81.5% respectively.

2. Continuous Play of the Guarantee Function of Maternity Insurance System
In 2024, 252,995,200 people participated in maternity insurance, an increase of 3,963,800 people or 1.6% over the previous year. In 2024, 36.908 million person-times received various maternity insurance benefits, an increase of 30.2% over the previous year; the expenditure of maternity insurance fund was 14,029.3 million yuan, an increase of 19.2% over the previous year. As of the end of 2024, 31 provinces and the Xinjiang Production and Construction Corps have included assisted reproductive services into medical insurance coverage.
Table: Number of Maternity Insurance Participants and Benefit-Recieving Person-times, 2020-2024 (Unit: 10,000 persons, 10,000 person-times)
Note: Starting from 2023, the caliber of the number of people receiving maternity insurance benefits has been expanded to include the number of prenatal examination person-times.

3. Continuous Enhancement of the Bottom-line Guarantee Function of Medical Assistance
In 2024, the national medical assistance expenditure was 79,232 million yuan, and the medical assistance fund supported 79,156,700 people[1] to participate in basic medical insurance, implemented outpatient and inpatient assistance for 180,906,100 person-times, with the average per capita inpatient assistance and outpatient assistance being 1,254 yuan and 92 yuan respectively. In 2024, the central fiscal arrangement of medical assistance subsidy funds was 29.7 billion yuan.
Table: Medical Assistance Expenditure and Supported Participants, 2020-2024 (Unit: 100 million yuan, 10,000 persons)
[1] The number of people assisted by medical insurance to participate in basic medical insurance does not include the number of people assisted by other departments.

4. Significant Achievements in Coordinated Development and Governance of "Three Medical Fields" (Medical Care, Medical Insurance, Pharmaceutical Industry)
(1) Medical Insurance Drug Catalog
The National Drug List for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (2024) contains a total of 3,159 Western medicines and proprietary Chinese medicines, including 1,765 Western medicines and 1,394 proprietary Chinese medicines. 91 new medicines were added in 2024.
Table: Number of Western Medicines and Proprietary Chinese Medicines Included in National Medical Insurance Drug Catalog, 2020-2024 (Unit: species)
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. In 2024, 280 million person-times used negotiated drugs within the agreement period.

(2) Reform of Medical Insurance Payment Method
As of the end of 2024, full coverage has been basically achieved for overall planning areas eligible for disease-specific payment and eligible medical institutions. The proportion of discharged patients under disease-specific payment exceeded 90%, and the fund expenditure under disease-specific payment accounted for about 80% of the total eligible inpatient medical insurance fund expenditure. More than 90% of overall planning areas have established a special case negotiation mechanism, and all overall planning areas have established medical insurance data working groups.

(3) Centralized Procurement of Drugs and Medical Consumables
In 2024, the 10th batch of national organized drug centralized procurement was carried out, covering 62 types of drugs; the 5th batch of national organized high-value medical consumables centralized procurement was carried out, covering 2 types: peripheral vascular stents and cochlear implants. Up to now, a total of 10 batches of national organized drug centralized procurement have been carried out, including 435 types of drugs; 5 batches of national organized high-value medical consumables centralized procurement have been carried out, covering 7 categories of high-value medical consumables in the fields of cardiology, orthopedics, ophthalmology, etc.

5. Continuous Optimization of Off-site Medical Settlement Services
In 2024, the number of off-site medical visits for general outpatient and emergency services, chronic outpatient special diseases, and inpatient services reached 397 million person-times, including 262 million person-times under EBMI and 134 million person-times under RBMI. The total off-site medical expenses for general outpatient and emergency services, chronic outpatient special diseases, and inpatient services were 786,774 million yuan, including 318,414 million yuan under EBMI and 468,361 million yuan under RBMI.
Table: National Off-site Medical Visits and Expenses, 2020-2024 (Unit: 10,000 person-times, 100 million yuan)

6. Strengthened Supervision of Medical Insurance Funds
In 2024, the national medical insurance system recovered a total of 27.5 billion yuan of medical insurance funds. Among them, 23.363 billion yuan of fund losses were recovered through handling service agreements, and the rejected or recovered funds involved 289,900 designated medical institutions and pharmacies. A total of 2,008 institutions involved in insurance fraud were verified, 3,018 medical insurance cases were jointly investigated by public security organs, and 10,741 criminal suspects were arrested. 3.1 billion yuan of fund losses were recovered through the intelligent supervision subsystem. A total of 754 person-times received report rewards, with a total reward amount of 1.866 million yuan.

7. Steady Progress of Long-term Care Insurance (LTCI) Pilot
In 2024, a total of 187,863,400 people participated in long-term care insurance in 49 pilot cities, and 1,462,500 people received benefits. The fund income in 2024 was 27.96 billion yuan, and the fund expenditure was 13.108 billion yuan. There were 8,837 designated service institutions for LTCI and 292,800 nursing service personnel.
Table: Number of LTCI Participants and Benefit-Recieving Persons, 2020-2024 (Unit: 10,000 persons)
Table: LTCI Fund Income and Expenditure, 2020-2024 (Unit: 100 million yuan)

8. Medical Insurance Continuously Empowers Economic and Social Development
(1) Empowering the Development of the "Three Medical Fields"
Since the establishment of the NHSA, the cumulative expenditure of medical insurance funds has reached 16.57 trillion yuan, with an average annual growth rate of 11%. This has not only provided a solid guarantee for the general public's medical treatment, but also strongly supported the development of the pharmaceutical industry, the progress of medical technology, and the improvement of industrial capabilities.
Table: Medical Insurance Fund Expenditure, 2018-2024 (Unit: 10 trillion yuan)

(2) Empowering Innovation in the Pharmaceutical Industry
A medical insurance access and negotiation renewal mechanism centered on new drugs has been established, greatly shortening the time from the launch of innovative drugs to their inclusion in medical insurance. From 2018 to 2024, the sales of newly added drugs under the medical insurance negotiation during the agreement period exceeded 540 billion yuan, of which the medical insurance fund expenditure exceeded 370 billion yuan.

(3) Empowering Participants to Seek Medical Care and Purchase Medicines
The reform of the employee medical insurance outpatient mutual aid system has been deepened, expanding the scope of eligible personnel and the scope of fund use for individual accounts. The family mutual aid scope of EBMI individual accounts has been expanded to close relatives, and the fund use has gradually expanded from intra-provincial mutual aid to cross-provincial mutual aid. In 2024, the mutual aid use of individual accounts reached 51.2 billion yuan, promoting the activation of existing funds and effectively reducing the medical burden of participants.

Note: Some data in this communiqué are rounded, so the total and the sum of sub-items may differ slightly.

China Healthcare Security: Lifelong Protection! Everyone is responsible for safeguarding the safety of medical insurance funds! Reporting hotline for insurance fraud crackdown: 010-89061396, 010-89061397; Email: [e-mail].

搜集汇总

背景与挑战

背景概述

该数据集提供了2024年全国医疗保障事业发展的全面统计数据，涵盖基本医疗保险、生育保险、医疗救助等多个方面。关键信息包括：全国基本医疗保险参保人数达13.27亿人，参保率巩固在95%；医保基金总收入34913.37亿元，支出29764.03亿元，累计结存38628.52亿元，显示基金运行安全稳健。数据集特点在于数据详实，涉及职工医保和居民医保的参保结构、基金收支、待遇享受等细分指标，并反映了医保政策改革、异地就医优化和基金监管等方面的进展。