Recently, most areas of the country have completed the centralized collection of medical insurance fees for urban and rural residents, and the insured people have enjoyed medical security services. What is the situation of the nation's participation in basic medical insurance? Is the standard for residents' medical insurance payment reasonable? Do residents who are not sick "suffer a loss" in participating in basic medical insurance? A responsible person of the relevant department of the State Medical Insurance Bureau was interviewed by this reporter on issues of concern to society.
Q: Some people say that the number of urban and rural residents in mainland China has been declining in recent years. It is also said that there is a "wave of medical insurance withdrawal" in rural areas in some areas. Is this true?
A: This statement is not accurate. The coverage of basic medical insurance in mainland China has remained stable at more than 95%, and the quality of insurance coverage has continued to improve.
From a macro point of view, the number of residents participating in medical insurance remained stable. There have been slight fluctuations in the data in recent years, mainly due to two reasons. The first is insurance data governance. Since 2022, the medical insurance department has taken the opportunity of the launch of the national unified medical insurance information platform to clean up a total of 56 million cross-provincial and intra-provincial duplicate insurance data of residents' medical insurance for two consecutive years. This is the main reason for the fluctuation of residents' medical insurance participation data. The second is the optimization of the insurance structure. From 2020 to 2023, 5 million to 8 million insured people will switch from participating in resident medical insurance to participating in employee medical insurance every year, resulting in the number of residents and employees participating in medical insurance.
From a micro point of view, the National Health Insurance Administration recently sent special personnel to Inner Mongolia, Heilongjiang, Henan, Hubei, Hunan, Sichuan, Gansu and other 8 provinces in 8 villages with relatively weak work foundation to carry out research on insurance work. According to the survey, among these 8 villages, 5 villages will have an increase in the number of people participating in resident medical insurance in 2023 compared with 2022, 3 villages will have a slight decrease in the number of insured people, and the overall number of insured people in 8 villages will increase by 151 compared with 2022. Taking a village in Macheng City, Hubei Province, where "multiple people surrender" is reported on the Internet, as an example, the field survey found that in 2023, 97.4% of the residents of the village will participate in medical insurance, and 30 new people will actually be insured, and only one case will not be insured due to special reasons. Many villagers said that they were fortunate to have medical insurance, which effectively solved their worries about seeking medical treatment.
However, it should also be noted that with the continuous development of the aging and declining birthrate of the mainland's population, especially with the decline of the total population of the mainland, the number of residents participating in medical insurance may also decline slightly in a stable manner in the future, and even the total number of insured people may also shrink.
Q: In 2023, the individual payment standard for medical insurance for urban and rural residents in mainland China is 380 yuan. Some people think that the cost standard is too high and the rate of increase is too fast. What should we make of this view?
Answer: Some public opinion believes that compared with the payment standard of 10 yuan/person when the "New Rural Cooperative Medical System" was established in 2003, the current payment standard of 380 yuan/person for residents' medical insurance has increased too fast. However, we should not simply look at the increase in the payment standard, but also look at what the increase of 370 yuan has brought to the broad masses of the people. In fact, behind the rise in medical insurance financing standards is a greater improvement in the level of medical insurance services.
First, the scope of protection for the masses has been markedly expanded. In 2003, when NCMS was established, there were only about 300 kinds of drugs that could be reimbursed, and almost no reimbursement was made for the treatment of cancer, rare diseases, etc., and the treatment methods for patients suffering from serious diseases were very limited. At present, there are 3,088 kinds of drugs included in the mainland medical insurance drug list, covering more than 90% of the drug amount of public medical institutions, including 74 tumor targeted drugs and more than 80 drugs for rare diseases. In particular, many new drugs and good drugs can be included in the medical insurance catalogue according to regulations soon after they are marketed in China. Since the establishment of the National Health Insurance Bureau in 2018, after the drug was collected and reimbursed by medical insurance, the out-of-pocket cost of patients taking drugs per year has been reduced to about 6,000 yuan, and the continuous improvement of the medical insurance system has rekindled the hope of countless patients and families.
Second, all kinds of modern medical examination and diagnosis and treatment techniques are more accessible. Over the past 20 years, with the strong support of the medical insurance policy, the medical service capacity has achieved leapfrog development, and the diagnosis and treatment capacity of major diseases is on par with the international advanced level, leading the world in some fields. The medical examination and diagnosis and treatment methods enjoyed by patients are moving towards digitalization, intelligence and precision, and high-tech equipment such as color ultrasound, CT and MRI are rapidly popularized, and painless surgery, minimally invasive surgery and other diagnosis and treatment technologies that used to be high and out of reach are becoming more and more popular and included in the scope of medical insurance reimbursement, and the majority of insured patients have enjoyed more high-quality medical services.
Third, the proportion of medical reimbursement for the masses has increased significantly. In 2003, at the beginning of the establishment of the NCMS system, the reimbursement rate of hospitalization expenses within the policy scope was generally about 30%-40%, and the proportion of self-payment by the masses was relatively high, and the burden of medical treatment was heavy. At present, the reimbursement ratio of hospitalization expenses within the policy scope of mainland residents' medical insurance is maintained at about 70%, and the burden of medical treatment on the masses has been significantly reduced, which will inevitably bring about an increase in the financing standard of medical insurance. At the same time, with the deepening of the aging of the mainland's population, the improvement of the medical needs of the masses, and the improvement of the level of medical consumption, it is also necessary to strengthen the raising of medical insurance funds to provide stable and sustainable protection for the masses.
Fourth, the level of service capacity for the masses has been improved by leaps and bounds. In 2003, the participants of the "New Rural Cooperative Medical System" could only be reimbursed for medical treatment in the county (district) hospital, and the reimbursement rate for medical treatment in other places was reduced a lot, and they could not be directly settled. At present, the residents who participate in the medical insurance can not only enjoy medical reimbursement in their own counties (districts), cities (prefectures) and provinces, but also enjoy direct settlement services for inter-provincial hospitalization expenses in nearly 100,000 designated medical institutions across the country, providing a solid guarantee for the masses who live, travel and work in other places to seek medical treatment. In addition, the outpatient medication guarantee mechanism for hypertension and diabetes has been established from scratch, so that the masses no longer have to worry about the money for buying medicines, helping about 180 million urban and rural residents with "two diseases" to reduce the burden of medication by 79.9 billion yuan, and the "triple guarantee system" will benefit more than 180 million low-income people in rural areas to seek medical treatment in 2023 alone, helping to reduce the burden of medical expenses by more than 180 billion yuan.
In the past 20 years, although the per capita financing standard of residents' medical insurance has increased by 370 yuan, the benefits brought to the masses by the improvement of medical security level and service are far from measurable from the 370 yuan. In fact, in order to support the substantial improvement of the capacity and level of medical insurance services, the state has adjusted the annual insurance payment standard for individual residents, and the financial subsidies for residents to participate in the insurance have been increased by a greater margin. From 2003 to 2023, the subsidy provided by the state government to residents for insurance participation increased from no less than 10 yuan to no less than 640 yuan. If a resident is continuously insured from 2003 to 2023, the total medical insurance premium is at least 8,660 yuan, of which the total financial subsidy is at least 6,020 yuan, accounting for about 70% of the total premium, and the total amount of individual resident contributions is 2,640 yuan, accounting for only about 30% of the total premium.
With the strong support of the continuous improvement of the medical insurance system, the demand for medical treatment of residents across the country has been rapidly released, and the health level has been significantly improved. According to statistics, from 2003 to 2022, the total number of medical and health institutions in mainland China increased from 2.096 billion to 8.42 billion, and the average life expectancy of residents in China increased from 72.95 years in 2005 to 77.93 years in 2020. At the same time, the share of personal health expenditure in the country's total health expenditure has dropped sharply from 55.8% in 2003 to 27.0% in 2022. Behind the fact that nearly 1.4 billion medical insurance participants enjoy higher levels of medical conditions, a wider range of medical insurance, a higher proportion of medical insurance reimbursements, and more convenient medical insurance services, China's medical insurance system escorts people's lives and health.
Q: Do all the medical insurance reimbursement enjoyed by urban and rural residents come from the individual payment of residents?
Answer: The premium of medical insurance for urban and rural residents is paid annually, and the financing standard in 2023 is 1,020 yuan/person, of which the financial subsidy is not less than 640 yuan/person, which is the bulk of the financing, and the individual payment standard is 380 yuan, which is only the small part of the financing, and for the low-income households and other difficult people, the financial department will also give full or partial subsidies.
The medical premiums paid by residents, together with financial subsidies, form a common basic medical insurance fund pool for the majority of urban and rural residents in the mainland, which brings about a continuous improvement in the level of basic medical insurance for the masses. Here, I would like to add a few data for 2023: first, the total amount of individual medical insurance payments for urban and rural residents in the country will be 349.7 billion yuan, second, the financial payment subsidy for residents will be 697.759 billion yuan, and third, the annual expenditure of the resident medical insurance fund will be 1,042.3 billion yuan. The total annual expenditure of the resident medical insurance fund is 2.98 times the total amount of individual residents' contributions.
Q: What do you think of remarks such as "I didn't get sick after paying medical insurance, but I suffered a loss"?
A: The occurrence of diseases is often uncertain. In modern society, it is difficult for individuals and families to afford the high cost of treatment in the face of sudden and serious diseases. The essence of insurance is to bring together the efforts of all parties to help individuals and families who are unfortunate enough to suffer from serious illnesses to resist the risk of large medical expenses. Therefore, participating in medical insurance is "protection when you are sick and benefiting others when you are not sick", which should be a rational choice for every person when facing the uncertainty of disease risk.
In 2022, there were 8.42 billion outpatient visits in medical and health institutions across the country, with an average of 6 visits per person a year. There are 247 million admissions to health institutions nationwide, with an annual hospitalization rate of 17.5 per cent, that is, an average of 1 in 6 people is admitted to a hospital once a year. The probability of residents getting sick and seriously ill is not as low as imagined. During the previous poverty alleviation period, 40% of poverty was caused by illness and returned to poverty due to illness, which also shows that the impact of illness on the economic situation of families is great.
According to the data, in 2022, the average hospitalization expenses of mainland residents with medical insurance will be 8,129 yuan, calculated at a reimbursement ratio of 70%, and the average reimbursement of medical insurance for one hospital stay will be 5,690 yuan, and if residents save the premiums paid by individuals who have participated in the insurance from 2003 to 2023, compound interest will be calculated at an annual interest rate of 5%, and the principal and interest will be 3,343.1 yuan by 2023. In other words, the amount of medical insurance reimbursement after a resident stays in the hospital far exceeds the income of saving the total personal premium for 20 consecutive years.
Therefore, the statement that "I didn't get sick after paying medical insurance, but I suffered a loss" is not correct, and it is not cost-effective from the point of view of accounting.
Q: Some netizens said, "Young people who are in good health can not be insured, and only the elderly and children can be insured." What do you think of this view?
A: This view is somewhat representative of some people. But if you consider all factors comprehensively, you will find that this is actually "calculating small accounts and suffering big losses".
First, the spectrum of diseases on the mainland is changing. With the development of modern science and technology, more and more diseases have been detected and diagnosed early, especially with the acceleration of the pace of modern life, the increase of work pressure and living habits, hypertension, diabetes, heart disease, malignant tumors, etc., the trend of younger age, and the health risks faced by young adults should not be underestimated.
Second, young adults are more vulnerable to the risk of disease. Once suffering from a major illness, if there is no medical insurance, it not only means that the family will bear huge treatment costs, but also means that the family will lose an important source of income. This double blow will not only have a disastrous impact on the family financially, but will also further affect the education and growth of children. Therefore, the "pillars" of the family need to be escorted by medical security.
To sum up, young adults should be insured. It's not just for yourself, it's about providing security for parents, children, and families.
In the next step, the National Health Insurance Administration will continue to give full play to the certainty of the mainland's basic medical insurance system to cope with the uncertainty of disease risks, do its best and do what it can, and strive to alleviate the burden of medical treatment for the masses, and provide better medical insurance services for the masses.
Source: National Health Insurance Administration