According to the official website of the National Medical Insurance Administration, from January to December 2023, the operation of direct settlement for cross provincial and cross regional medical treatment was basically stable, with 129 million people settling directly for cross provincial and cross regional medical treatment, a decrease of 153.674 billion yuan in advance payments from insured individuals, an increase of 238.67% and 89.91% respectively compared to 2022. The scale of cross provincial direct settlement of hospitalization expenses has further increased. As of the end of December 2023, the number of cross provincial networked designated medical institutions for hospitalization expenses in China reached 82300, an increase of 19600 compared to the end of 2022. From January to December 2023, the national hospitalization expenses were directly settled across provinces for 11.2548 million people, reducing personal advances by 13.5126 billion yuan, an increase of 97.87% and 77.25% respectively compared to 2022. In the fourth quarter of 2023, the national hospitalization expenses were directly settled across provinces for 3.1793 million people, reducing personal advances by 36.619 billion yuan, an increase of 1.76% and 1.15% respectively compared to the third quarter. The scope of direct settlement of outpatient expenses across provinces has been further expanded. At present, all the planning areas have opened cross provincial direct settlement services for general outpatient expenses and cross provincial direct settlement services for treatment expenses related to chronic and special diseases in five outpatient clinics, including radiotherapy and chemotherapy for hypertension, diabetes, malignant tumor, uremia dialysis, and anti rejection treatment after organ transplantation. As of the end of December 2023, the number of cross provincial networked designated medical institutions for general outpatient expenses in China was 193900, the number of cross provincial networked designated medical institutions for outpatient treatment of chronic diseases was 58000, and the number of cross provincial networked designated retail pharmacies was 352400, an increase of 118.6%, 305.59%, and 55.79% respectively compared to the end of 2022. From January to December 2023, 118 million outpatient expenses were directly settled across provinces nationwide, reducing personal advances by 18.548 billion yuan, an increase of 263.36% and 295.9% respectively compared to 2022; Among them, 3.31 million outpatient treatment expenses related to chronic diseases were directly settled across provinces nationwide, reducing personal advance payments by 3.352 billion yuan, an increase of 12.34 times and 12.97 times respectively compared to 2022. In the fourth quarter of 2023, 41.3968 million outpatient expenses were directly settled across provinces nationwide, reducing personal advances by 6.541 billion yuan, an increase of 24.22% and 26.08% respectively compared to the third quarter. Among them, 1.3955 million outpatient expenses related to chronic diseases were directly settled across provinces nationwide, reducing personal advances by 1.49 billion yuan, an increase of 39.13% and 45.08% respectively compared to the third quarter. The nationwide unified online filing service function has been further expanded. At present, all staff medical insurance and resident medical insurance participants can achieve cross provincial and non local online medical records through the national medical insurance service platform APP and the national medical insurance bureau's WeChat official account. From January to December 2023, 8.0422 million people were successfully registered through the national unified online filing channel, an increase of 159.48% compared to 2022. At the same time, the national unified online query function includes cross provincial networking of designated medical institutions, consultation service phone numbers for medical insurance agencies, and popular information query services for shutdown announcements, gradually