Health Insurance Reforms
in China
YAN, FEI
Prof., Chair, Dept. of Social Medicine
School of Public Health, Fudan University
fyan@shmu.edu.cn
1
Outlines
• General introduction
• Development of Health Insurance Schemes
• Challenges & Strategies
2
General introduction
• The goal of the health reform is to establish a
primary health care and insurance system to
assure that every citizen has equal access to
affordable basic health care.
3
Health Insurance Reform
Public Welfare Health Insurance
Labour Health Insurance
Cooperative Medical Scheme
Public agencies
Enterprises
Rural residents
URBMI
UEBMI
NRCMS
The Urban Residentbased Basic Medical
Health Insurance
The Urban Employeebased Basic Medical
Health Insurance
The New Rural
Cooperative Medical
Scheme
(starting since 2007)
(launched in Dec. of 1998)
(starting since 2003)
MAF
Medical Assistant Funds for vulnerable people
(introduced between 2003 and 2007)
Supplementary and commercial health insurance plans
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Health Insurance Schemes
Name
Eligibilities
Management Service package
Source of fund
UEBMI
Urban employed,
pensioners,
& Self-employed
workers
Municipal
Department
of Human
Resources
and Social
Security
The premium is collected in
the form of a payroll tax, , 6%
of which is provided by
employers and 2% is
contributed by employees.
About 2000yuan in total.
For self-employed, individual
premiums.
URBMI
Children,
The same as
students, elderly, above
disabled, other
non-working
urban residents
Outpatient and
inpatient services
inpatient services
and catastrophic
illness, outpatient
services in some
areas
Premiums are pooled at the
municipal or prefectural level,
and contributed by individual
premium and subsidy of
government, government
subsidies make up over 70
percent of the total fund.
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Health Insurance Schemes
Name
Eligibilities
Management Service package
Source of fund
NRCMS
Rural
registered
residents
County NCMS Outpatient and
office
inpatient services
The premium is from individual
premium and subsidy of
government including local and
central government,
government subsidies make up
over 80 percent of the total
fund. The premium for poor is
by government.
Medical Vulnerable Civil Affairs
Assistant people
Department
Outpatient and
The fund is from special budget
inpatient services. by government
additional
reimbursement
after general
insurance.
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Development of NRCMS
History
• The RCMS was initiated in the late 1950s in China.
• RCMS was developing significantly in the 1960s
and 1970s, covering around 90% of Chinese
villages by end of 1970s, which were jointly
funded by individual contributions and the cooperative economy.
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• Unfortunately, RCMS collapsed in most places of
China in the mid 1980s when China’s agriculture
sector was privatized. Only about 5-10% of the
Chinese rural population, mostly in the richer eastern
coastal areas, were still covered by RCMS during the
1990s.
8
Development situation
• In 2002 the Central government sponsored a national
conference on rural health development in which a
document “Decision on further strengthening rural
health development”.
• The Decision proposed the establishment of new RCMS
with financial support from the central government to
reduce the number of people living in poverty that is
caused by serious illnesses and the payment of expensive
medical care.
• The NRCMS was launched in July 2003 in over 300
counties.
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Enrolment
• For expanding population coverage, a number of
strategies have been implemented, including:
- To increase government subsidies.
- To increase awareness of the families about benefits of
the schemes.
- To change the individual-based to family-based enrolment
policy.
- To simplify procedures of enrolment and reimbursements.
- To change timing for premium collection.
- To extend scope of services and benefit package to attract
people.
10
(%)
Enrollment rate (%)
11
Data from: China health statistics yearbook 2008,2014,2015
Management of NRCMS
• Implementing a finance mechanism of a combination
of government financial assistance, rural residents
enrollment premium, and collective economy
support
• Transferring payment by the public finance to the
middle and western China
• Aiding the poor rural residents to join in the NRCMS
and get additional subsidy from the Ministry of Civil
Affairs
• Taking the county as a pooled unit to enhance the
risk pooling ability
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• Embodied the main function of the government in
the development of the NRCMS
• The State Council established a joint-ministry
meeting system
• Guaranteeing the structure of the NRCMS
organization and leadership, and a sound running
mechanism.
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Benefit Package of the NRCMS
(by the end of 2008)
• Pooling fund offers to inpatient care for all enrollees,
with family medical savings accounts for outpatient
care (58.3%)
• Overall pooling fund offers to both inpatient and
outpatient care for all enrollees. (32.2%)
• Overall pooling fund offers to inpatient care (9.4%)
now
• Outpatient pooling fund extended
• Reimbursement proportion 50% outpatient care, 75%
inpatient care
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The catastrophic diseases covered by NRCMS in most areas
• 2010
•
•
Congenital
heart disease of
children
Acute leukemia
of children
•
2011
• 2012
•
Congenital heart
disease of children
Acute leukemia of
children
Breast cancer
Cervical cancer
Severe mental
illness
End-stage renal
disease
Multidrug-resistant
tuberculosis
Opportunistic
infection of AIDS
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Congenital heart disease of children
Acute leukemia of children
Breast cancer
Cervical cancer
Severe mental illness
End-stage renal disease
Multidrug-resistant tuberculosis
Opportunistic infection of AIDS
Lung cancer
Esophageal cancer
Gastric cancer
Colon cancer
Colorectal cancer
Chronic myelogenous leukemia
Acute myocardial infarction
Cerebral infarction
Hemophilia
Type Ⅰ diabetes
hyperthyroidism
Cleft lip and palate
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Yuan
Increasing of premium level of NRCMS
16
million
person-times
Reimbursement proportion 50% outpatient care, 75% inpatient care
Data from: China health statistics yearbook 2008,2014
17
a hundred million
Financing and expenditure of NRCMS
18
Data from: website of the National Bureau of Statistics
Progress of UEBMI
Million people
19
Data from: China health statistics yearbook 2008,2014,2015
Progress of URBMI
Million people
20
Data from: China health statistics yearbook 2008,2014,2015
Progress of MFA
（million
person-times)
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Data from: China health statistics yearbook 2008,2009,2014,2015
Health care untilisation
2003
Outpatients visit rate（%）
Un-visit rate (%)
Hospitalization rate during
last year (%)
2013
rural
urban
rural
urban
13.9
11.8
12.8
13.3
45.8
57.0
22.0
32.9
3.4
4.2
9.0
9.1
30.3
27.8
16.7
17.6
Un-hospitalization rate (%)
22
Data from: China National health household survey
Challenges
• Disparities in fund and benefit packages
between the schemes.
• Lack of mobility for the rural migrants.
• Inefficiency in operation of the schemes.
• Limited capacity for financial protection.
• Cost escalation (providers & users).
• Poor quality of medical care.
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Policy options
• To unify the three health insurance schemes.
• To use cross-region settlement
• To raise fund pooling level to increase financial
protection. (prefectural, provincial level)
• To adjust the contribution between
government and individuals.
24
Policy options
• To strengthen capacity of management and
administration of the schemes.
• To use provider payment systems to enhance
efficiency performance and quality of care of
the schemes.
• Cost containment (monitoring, payment
methods)
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Thanks for your attentions!
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