The healthcare security authorities have consistently maintained strict oversight and a high-pressure stance on fund supervision in recent years. Concurrently, there is a strong emphasis on combining enforcement with prevention and moving the point of control forward. Significant efforts have been made to implement pre-emptive alert systems in designated healthcare institutions, aiming to eliminate various illegal and non-compliant issues in their "infancy" and reduce their occurrence at the source.

Key Measures for Implementation

The first measure involves proactively disclosing regulatory rules. The authorities have publicly issued the "Healthcare Security Fund Intelligent Supervision Rules and Knowledge Base (2025 Edition)," which comprehensively includes nearly 250,000 rules and knowledge points. These intelligent supervision rules and knowledge points are continuously published through the official website and public account of the National Healthcare Security Administration. This initiative helps medical personnel better understand and master healthcare fund supervision rules, assisting designated healthcare institutions in enhancing their self-management capabilities.

The second measure focuses on vigorously promoting the construction of pre-emptive alert systems. Leveraging the healthcare information platform, a comprehensive pre-emptive intelligent alert system has been developed and improved. All designated healthcare institutions can access and utilize this system free of charge. It provides reminders, warnings, and can intercept potential violations during the diagnosis and treatment process conducted by medical staff.

The third measure supports personalized management applications. For healthcare institutions with stronger technical capabilities and better information technology infrastructure, they are encouraged to embed the nationally published "two-base" rules and knowledge points into their Hospital Information Systems (HIS). This integration aims to improve operational efficiency and meet the needs for customized management.

Current Integration Progress and Data

According to data from the National Healthcare Information Platform, as of June 30th, the nationwide integration rate of the pre-emptive alert system in designated healthcare institutions has reached 71%. This achievement surpasses the 70% integration target set at the beginning of the year ahead of schedule.

Specifically, the integration rate for designated retail pharmacies stands at 82%, while for designated medical institutions it is 65%. Among medical institutions, the integration rates for tertiary, secondary, and primary & below levels are 92%, 85%, and 64% respectively. Public medical institutions have an integration rate of 62%, compared to 76% for private medical institutions.

On a provincial level, nine provinces—Anhui, Hubei, Tianjin, Hebei, Jilin, Heilongjiang, Fujian, Gansu, Guizhou—along with the Xinjiang Production and Construction Corps, have achieved integration rates exceeding 90%. From January to June this year, the healthcare intelligent supervision pre-emptive alerts have been triggered a cumulative 56.05 million times, involving amounts totaling 129 billion yuan.

Future Development Plans

Moving forward, the National Healthcare Security Administration will guide healthcare security departments at all levels to continuously optimize and improve the pre-emptive alert system. The intelligent supervision rules and knowledge base will be dynamically updated and made publicly available to provide robust support for the pre-emptive alert initiative. This effort will continue to empower the vast number of designated healthcare institutions, with the goal of achieving full coverage of pre-emptive alerts across all designated healthcare institutions during the "15th Five-Year Plan" period.