From 10 yuan to 380 yuan, what has the increased medical insurance payment brought to the masses?

Recently, the centralized payment of medical insurance for urban and rural residents in most areas of the mainland has ended one after another. On the 25th, the National Health Insurance Administration responded to hot spots related to medical insurance payment.

From the 10 yuan/person payment standard when the NCMS was established in 2003 to the current 380 yuan/person payment standard, is the increase of 370 yuan in medical insurance payment reasonable?

The inclusion of new drugs continues to "expand" medical security

In response to the increase in payment from 10 yuan to 380 yuan, the person in charge of the relevant department of the National Health Insurance Bureau said that behind the rise in medical insurance financing standards is a greater improvement in the level of medical insurance services.

In 2003, when NCMS was established, only 300 kinds of drugs could be reimbursed, but now 3,088 drugs are covered by medical insurance, and many tumors and rare diseases have achieved "zero breakthroughs" in medical insurance drugs, reaching 74 and 80 kinds respectively...... In recent years, more patients have been able to afford and receive medicines.

In the pharmacy of the First Affiliated Hospital of Guangxi Medical University, pharmacists are dispensing medicines for patients. (Photo courtesy of the First Affiliated Hospital of Guangxi Medical University)

Transthyretin amyloidosis patients are one of the beneficiary groups, they are also known as "starch people", although the drug used for treatment, chloraventzolic acid, was launched in China in 2020, but the price per box reached 60,000 yuan, which discouraged many patients.

"In 2021, the negotiation of chlorafanzole acid was successful, and now the monthly cost of medication for patients is less than 3,000 yuan. Tian Zhuang, chief physician of the Department of Cardiology of Peking Union Medical College Hospital, said that in the past two years, many new and good drugs have accelerated the speed of entering the medical insurance, and they can be included in the medical insurance catalog according to the regulations soon after they are listed in China, bringing good news to patients.

At the beginning of 2024, the latest version of the medical insurance drug list will be implemented, including 126 new drugs such as oncology drugs, chronic disease drugs, and rare disease drugs.

According to the person in charge of the relevant department of the National Health Insurance Administration, at present, the drugs included in the mainland medical insurance drug list have covered more than 90% of the drug amount of public medical institutions. Only during the 2023 agreement period, the negotiated drug price reduction and medical insurance reimbursement have reduced the burden on patients by more than 200 billion yuan.

With the continuous "expansion" of medical insurance, modern medical examination and diagnosis and treatment technologies have become more accessible, and diagnosis and treatment technologies such as painless surgery and minimally invasive surgery have become increasingly popular and included in the scope of medical insurance reimbursement.

According to the person in charge of the relevant department of the National Health Insurance Bureau, it is precisely because of the continuous improvement of the medical insurance system that 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 visits to medical and health institutions in mainland China increased from 2.096 billion to 8.42 billion, while the proportion of personal health expenditure in the country's total health expenditure decreased from 55.8% in 2003 to 27.0% in 2022.

The person in charge said that with the deepening of the aging of the mainland's population, the improvement of the medical needs of the masses, and the improvement of medical consumption, it is necessary to strengthen the raising of medical insurance funds to provide stable and sustainable protection for the masses.

Reduce out-of-pocket medical insurance reimbursement ratio

According to the latest "2022 Statistical Communiqué on the Development of Health Undertakings in the Mainland" released by the National Health Commission, in 2022, the total number of outpatient visits to medical and health institutions nationwide was 8.42 billion, with an average of 6 visits to medical and health institutions per person, and 247 million admissions to medical and health institutions nationwide, with an average hospitalization cost of 10,860.6 yuan.

The probability of residents getting sick or getting seriously ill is inevitable, and diseases still bring a certain economic burden to many patients.

According to the person in charge of the relevant department of the National Health Insurance Administration, at the beginning of the establishment of the "New Rural Cooperative Medical System" system in 2003, the reimbursement ratio of hospitalization expenses within the policy scope was generally 30% to 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 rate of hospitalization expenses within the policy scope of resident medical insurance is about 70%. In 2022, the reimbursement rates of hospitalization expenses in tertiary, secondary, and primary medical institutions will be 63.7%, 71.9%, and 80.1%, respectively.

In recent years, measures have been implemented to continuously improve outpatient security measures, enhance the functions of serious illness insurance and medical assistance, and reasonably increase the treatment of maternity medical expenses for residents' medical insurance, so as to further reduce the burden of self-payment on the masses.

For example, the outpatient medication guarantee mechanism for hypertension and diabetes has been continuously optimized from scratch, and has reduced the drug burden of about 180 million urban and rural residents by 79.9 billion yuan.

In order to support the improvement of medical insurance service capacity, the state has adjusted the annual insurance payment standard for individual residents, and the financial subsidy for residents to participate in insurance has been increased simultaneously.

From 2003 to 2023, the subsidy from the state government for residents to participate in insurance has increased from no less than 10 yuan per person to no less than 640 yuan per person, and the government will give full or partial subsidies to people in difficulty such as low-income households.

According to the data of the National Health Insurance Administration, in 2023, the total amount of individual medical insurance contributions for urban and rural residents in mainland China will be 349.7 billion yuan, and the financial subsidy for residents will be 697.759 billion yuan. The annual expenditure of the resident medical insurance fund was 1,042.3 billion yuan, much higher than the total amount of individual residents' contributions.

As an important supplement to residents' medical insurance, financial subsidies and individual payments have jointly built a pool of basic medical insurance funds for urban and rural residents to enhance risk resistance.

Medical insurance is not a trivial matter, and the service is iteratively upgraded

Nearly 100,000 designated medical institutions across the country enjoy direct settlement services for inter-provincial hospitalization expenses, more than 1 billion users of medical insurance electronic vouchers, and 132 convenient measures in the field of medical insurance have been launched in various localities in combination with actual conditions...... In recent years, the trivial matter of medical insurance is "not small", and a series of medical insurance services for the convenience and benefit of the people have been continuously iteratively upgraded.

In 2003, for example, the people who participated in the NCMS could only be reimbursed for medical treatment in their own county (district) hospitals.

Today, the direct settlement of cross-provincial and non-local medical treatment has been promoted nationwide, and nearly 100,000 designated medical institutions across the country have carried out the direct settlement service of inter-provincial hospitalization expenses.

According to the data, in 2023, there will be 550,000 inter-provincial and remote medical treatment networked medical institutions, benefiting 130 million people seeking medical treatment, and reducing the advance payment of 153.67 billion yuan from the masses.

"From the perspective of expanding the scope of medical insurance protection, improving medical insurance treatment, and optimizing medical insurance services, the cost performance of medical insurance for urban and rural residents is relatively high. Wang Zhen, director of the Public Economics Research Office of the Chinese Academy of Social Sciences, said.

The National Health Insurance Administration said that participating in medical insurance "has protection when you are sick and benefits others when you are not sick" should be a rational choice for every person when facing the uncertainty of disease risk.

This year's National Medical Security Work Conference proposed that it is necessary to study and improve the long-term incentive and restraint mechanism for participating in insurance, and use the system to ensure that the masses who continue to pay premiums benefit and ensure that the whole people participate in insurance.

Source: Xinhuanet