The year 2021 is the opening year of the 14th Five-Year Plan period. Recently, the National Health Insurance Administration released the "National Health Insurance Development Statistics Bulletin for 2021", which fully reflects that the national health insurance system has thoroughly implemented the decisions and plans of the Party Central Committee and the State Council, in accordance with the "14th Five-Year Plan for National Health Insurance" issued by the General Office of the State Council and the National Health Insurance Work Conference for 2021. In accordance with the development goals and tasks set by the General Office of the State Council and the National Medical Security Work Conference in 2021, the national medical insurance system has comprehensively deepened the reforms in the field of medical security, strived to promote the high-quality development of medical security, and made remarkable achievements, creating a new situation of reform and development in the field of medical security in the 14th Five-Year Plan period, and writing a new chapter in the vigorous development of China's medical security.

First, the number of insured persons has steadily increased, and the national medical insurance continues to be consolidated

By the end of 2021, 1.363 billion people were enrolled in basic medical insurance, a slight increase over the previous year, and the enrollment rate remained stable at over 95%. Among them, the number of employees' medical insurance participants was 354 million, an increase of 9.76 million or 2.8% over the previous year, of which 261 million were working employees, an increase of 2.7% over the previous year. Among them, the number of participants in enterprises, institutions, flexible employment and other personnel increased by 7.26 million, 1.48 million and 1.01 million respectively over the previous year. At the same time, the number of urban and rural residents in basic medical insurance coverage of 1.009 billion people, 8.1 million less than the previous year, a decline of 0.8%, the same rate of decline as the previous year. In the past three years, residents' medical insurance and employees' medical insurance in terms of the number of participants continue to show the trend of this and that, this trend is conducive to the steady development of universal medical insurance.

Second, the health insurance fund income and expenditure situation has improved significantly, and the anti-risk strength has increased significantly

In 2021, as the new pneumonia epidemic is effectively controlled and most industries gradually return to normal, the income and expenditure of local health insurance funds will also improve accordingly. From the national basic medical insurance fund (including maternity insurance) income and expenditure as well as the balance in 2021, all the major indicators show significant growth. According to statistics, in 2021, the total income of the national basic medical insurance (including maternity insurance) fund was 2.87 trillion yuan, an increase of 15.6% over the previous year; the total expenditure of the basic medical insurance (including maternity insurance) fund was 2.40 trillion yuan, an increase of 14.3% over the previous year; and the accumulated balance of the basic medical insurance (including maternity insurance) fund increased to 3.62 trillion yuan. Among them, the accumulated balance of the employee medical insurance (including maternity insurance) fund (including maternity insurance) reached 1.77 trillion yuan, an increase of 15.39% over the previous year, and the number of months available for payment was 22.8 months, so as to prepare for the uncertainty of the future economic development situation and the increasing pressure on the fund income and expenditure.

Third, the number of people receiving medical insurance benefits and the average cost of hospitalization per visit continue to grow

In 2021, with the gradual improvement of the epidemic prevention and control situation, the insured people basically return to normal medical conditions and enjoy the corresponding medical insurance treatment. Among them, the number of people receiving treatment for employees' medical insurance reached 2.040 billion, an increase of 13.9% over the previous year. Among them, the number of hospitalizations was 59 million, an increase of 11.8% over the previous year; the average hospitalization cost was 12,948 yuan, an increase of 2.3% over the previous year, remaining basically stable. The number of people who participated in the residents' health insurance treatment reached 2.081 billion, an increase of 4.7% over the previous year. Among them, 153 million people were hospitalized, basically the same as the previous year; the average cost of hospitalization was RMB 8,023 yuan, an increase of 6.3% over the previous year, with a larger increase.

Fourth, medical assistance for low-income groups to participate in insurance and medical care to provide strong protection

Medical aid is an important part of the multi-level medical security system, and plays an important role in preventing the low-income population from falling into poverty and returning to poverty due to illness. The state attaches great importance to medical aid and has been increasing its financial investment in medical aid. 2021 medical aid expenditure was 61.990 billion yuan, of which the central government arranged 30.2 billion yuan in medical aid subsidies, an increase of 16.2% over the previous year. By funding 88.16 million people in low-income groups to participate in basic medical insurance, to ensure that the participation rate of the rural low-income population is stable at more than 99%. The implementation of outpatient and inpatient assistance exceeded 100 million times, reducing the burden of medical expenses of rural low-income people by RMB 122.41 billion, including an average of RMB 1,074 yuan per hospitalization, effectively reducing the burden of medical treatment on low-income groups.

V. Continue to carry out negotiations for access to the medical insurance drug catalog and continuously improve the medical insurance drug catalog

In 2021, the National Health Insurance Bureau further improved the drug evaluation index system, continued to organize negotiations for access to the medical insurance drug catalog, and released the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2021)". Through the national medical insurance drug list access negotiations and expert selection, 74 new drugs were added to the medical insurance drug list, with a focus on making up for the shortcomings in chronic diseases, rare diseases and anti-tumor drugs, increasing the total number of drugs in the new national medical insurance drug list to 2,860 in 2021. Through the negotiation of access to the National Health Insurance Drug List, 67 drugs have been reduced by an average of 62%. Through the establishment of a "dual-channel" guarantee mechanism for negotiated drugs, we will ensure the smooth entry of negotiated drugs into hospitals or pharmacies to meet the drug needs of patients. 400 million patients will benefit from price reductions and medical insurance reimbursement in 2021, of which 140 million will enjoy medical insurance reimbursement for 221 types of negotiated drugs, reducing the medical burden of patients by 1,494.9 million. Patients to reduce the medical burden of 149.49 billion yuan, so that the people fully enjoy the benefits of health insurance drug catalog access negotiations, price reductions and reimbursement.

Sixth, deepening medical insurance payment reform has achieved remarkable results

According to the deployment and requirements of the NHI on deepening health insurance payment reform, the key task of health insurance payment reform in 2021 is to promote the DRG and DIP pilot work according to local conditions and ensure that the DRG and DIP national pilot is transferred to the actual payment stage. 2021 In November, the NHI formulated and issued the "NHI Notice on Issuing DRG/DIP Payment Reform Notice of Three-Year Action Plan", proposing to accelerate the establishment of a managed and efficient health insurance payment mechanism and promote high-quality development of health insurance. Under the organization and guidance of the NHI, all 30 national pilot cities for payment by diagnosis-related groups (DRG) and 71 pilot cities for total budget and per-disease score (DIP) payment under the regional point method entered the actual payment stage in 2021, and DRG/DIP demonstration site cities were identified. Zhejiang and Guangxi are also promoting DRG payment reform throughout the province. By vigorously promoting DRG and DIP payment reform, significant results have been achieved in regulating hospital treatment behavior, effectively curbing the excessive growth of medical costs, and promoting the balance of income and expenditure of medical insurance funds.

VII. Giving full play to the strategic purchasing role of medical insurance in drug procurement

In 2021, the National Health Insurance Administration (NHA) will continue to implement the "Opinions of the General Office of the State Council on Promoting the Normalization and Institutionalization of Centralized Procurement of Pharmaceuticals", continue to carry out centralized procurement of pharmaceuticals, explore the construction of an alliance procurement mechanism, and improve the sunshine procurement system on provincial platforms. In 2021, the total amount of orders placed through the provincial centralized drug procurement platform exceeded the 1 trillion mark, reaching 1.03 trillion yuan, an increase of 11.04% over the previous year. Medicines in the medical insurance directory 825.9 billion yuan, accounting for 79.9% of the total amount of online procurement orders. Three batches of state-organized centralized quantity procurement of drugs were carried out throughout the year, involving 122 varieties, with an average price reduction of 52%. The first five batches of national centralized procurement of drugs and coronary stents were smoothly implemented, saving nearly 170 billion yuan in drug costs in 2021. Some places actively organize cross-provincial alliance centralized quantity procurement, and guide the unsuccessful drug gradient price reduction, also achieved significant results.

Eight, continue to expand the scope of direct settlement of foreign medical expenses and the beneficiary population

The implementation of direct settlement of medical expenses in other places is an effective measure to provide convenient and efficient medical insurance services for the majority of participants. Based on the cross-province direct settlement system established in recent years, the number and distribution of medical institutions connected to the cross-province direct settlement system will be further expanded in 2021. By the end of 2021, 53,000 medical institutions nationwide have been connected to the cross-province direct settlement system for inpatient expenses for medical treatment in different places, and every county has at least one medical institution connected to the system. At the same time, a comprehensive breakthrough has been made in the cross-province direct settlement of general outpatient expenses, which has covered all coordinated regions, with 128,000 medical institutions connected to the system, and more than 90% of counties have more than one medical institution connected to the system. In 2021, there were 64.34 million visits by employees' medical insurance participants for medical treatment in other places, and the total cost for medical treatment in other places was 166.3 billion yuan. The number of residents' medical insurance participants seeking medical treatment in other places is 43.18 million, and the cost of medical treatment in other places is 298.5 billion yuan. At the same time, all places in the foreign

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