Legal analysis: 1, the number of insured persons continues to increase. In 20 18, 3 168 10000 people participated in employee medical insurance, an increase of 4.5% over the previous year. Among them, 233.08 million employees, an increase of 4.6% over the previous year; There were 83.73 million retired employees, an increase of 4.2% over the previous year. On-the-job retirement ratio was 2.78, a slight increase year-on-year. Enterprises, institutions, flexible employment and other personnel (including employees and retirees) were 215.2 million, 61190,000 and 40.42 million respectively, increasing by 8.87 million,/kloc-0.59 million and 31respectively over the previous year. The number of employees participating in unified medical insurance and single medical insurance is 2900 1 10,000 and 26.8 million respectively, accounting for 9 1.5% and 8.5% of the total number of employees participating in medical insurance respectively.

2. The scale of fund revenue and expenditure has expanded. In 20 18, the income of employee medical insurance fund was1353.8 billion yuan, an increase of10.3% over the previous year; Fund expenditure was 65.438+00.707 billion yuan, an increase of 654.38+03.438+0% over the previous year. The collection rate of employee medical insurance fund in 20 18 was 99.4%, which was the same as last year; The aggregate income was 65.438+0.2935 billion yuan, accounting for 95.5% of the fund's income, accounting for 2.7 percentage points higher than the previous year. In 20 18, the income of the employee medical insurance pooling fund was 824 1 100 million yuan, an increase of 7.8% over the previous year; Overall fund expenditure was 649.4 billion yuan, an increase of12.7% over the previous year; The current balance of the overall fund is 65.438+0747 billion yuan, and the accumulated balance is 65.438+065.438+0466 billion yuan. In 20 18, the personal account income of employee medical insurance was 529.7 billion yuan, an increase of14.3% over the previous year; Personal account expenditure was 4.2/kloc-0.20 billion yuan, an increase of/kloc-0.3% over the previous year; Personal accounts accumulated108.4 billion yuan in the current period, totaling 728.4 billion yuan.

3. The number of people who enjoy treatment has increased. In 20 18, employees who participated in medical insurance enjoyed treatment19.8 billion person-times, an increase of 9.0% and 3.0 percentage points over the previous year. Among them, general outpatient and emergency 17 1 100 million person-times, an increase of 8.8% over the previous year; There were 265,438+10,000 outpatients with chronic diseases, an increase of 12.7% over the previous year. 60 million people were hospitalized, an increase of 6.7% over the previous year.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.