Interview with the National Health Insurance Administration: Residents' medical insurance is the most cost-effective in the world

Residents' medical insurance financing has always been based on financial subsidies, supplemented by individual payments, and financial subsidies are the main source of medical insurance funds for urban and rural residents. Visual China | fig

"Judging from the latest situation at the end of March 2024, the scale of residents' medical insurance participation is basically the same as that of the same period in 2023, and there is no so-called 'surrender wave' in some media. On April 11, 2024, at the regular press conference held by the National Health Insurance Administration in the first half of 2024, Zhu Yongfeng, deputy director of the Department of Planning, Finance and Regulations of the National Health Insurance Administration, once again responded to the "surrender wave".

Previously, some media reported that due to the rising cost of basic medical insurance for urban and rural residents (hereinafter referred to as resident medical insurance), some rural residents chose to stop paying. In an exclusive interview with Southern Weekly, the relevant person in charge of the National Health Insurance Administration said that the number of residents participating in medical insurance is generally stable, and there has been no major fluctuation after excluding the impact of factors such as duplicate insurance participation and transfer to employee medical insurance.

Different from employee medical insurance, resident medical insurance follows the principle of voluntary, and implements a combination of individual payment and government subsidies for financing. At present, the per capita financial subsidy standard for resident medical insurance is 640 yuan per year, and the individual payment standard is 380 yuan per year, an increase of 60 yuan compared with 2022.

A person in charge of the National Health Insurance Administration told Southern Weekend that although the standard of individual payment has risen, financial subsidies are still the main source of medical insurance funds for urban and rural residents. At the same time, we should not ignore the steady improvement of the level of medical security under the residents' medical insurance system in the past 20 years.

"In the past 20 years, we only need to pay 0.46 yuan per day for medical insurance, you can get a government subsidy of 1.12 yuan, you can enjoy better medical security, you can exchange for physical health and the increase in life expectancy from 72.26 years in 2003 to 78.2 years old now, it is very worthwhile, China's resident medical insurance can be said to be the world's most cost-effective medical insurance. The person in charge said.

The number of residents participating in medical insurance is generally stable, and it may decline slightly in the future

Southern Weekly: According to data released by the National Health Insurance Administration, the number of urban residents enrolled in medical insurance has been declining since 2019.

National Health Insurance Administration: Judging from the data we have, it can be said responsibly that the number of residents participating in medical insurance is generally stable, excluding the impact of factors such as duplicate insurance participation and transfer to employee medical insurance, and there has been no major fluctuation.

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 participation 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 be converted from participating in resident medical insurance to employee medical insurance every year, resulting in the number of residents and employees in medical insurance. Judging from the data of employees and residents, more than 1.3 billion people have firmly chosen to participate in insurance.

Southern Weekly: In response to the "wave of abandonment of medical insurance" mentioned in some previous media reports, what did the National Health Insurance Administration find in the field research?

National Health Insurance Administration: The National Health Insurance Administration recently sent special personnel to 8 villages in 8 provinces with relatively weak work foundations to carry out research on insurance participation. According to the survey, the number of people participating in resident medical insurance in 5 villages in 2023 will increase compared with 2022, the number of insured people in 3 villages will decrease slightly, 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 there is a "wave of surrender", 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. The data that some experts and media understand is the data in the process of insurance mobilization, and it is not easy to draw conclusions based on partial generalizations.

Of course, 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 steadily and slightly in the future, and even the total number of insured people may also shrink.

Pay 0.46 yuan per day for medical insurance, and get a government subsidy of 1.12 yuan

Southern Weekly: In 2023, the individual payment standard for residents' medical insurance will be raised to 380 yuan, how is the financing standard for residents' medical insurance and the individual payment standard calculated, and what are the reasons for the increase in individual payment?

National Health Insurance Administration: The determination of the financing standard for residents' medical insurance takes into account the per capita disposable income of residents, the strength of financial support, the ability of local management and the sustainability of the system, etc. The financing level of residents' medical insurance has been increasing year by year, not only to steadily improve the level of treatment, but also to the objective needs of medical technology progress, rapid growth of medical expenses, and the gradual release of residents' medical needs.

The main reasons for the increase in individual contributions for resident medical insurance are as follows:

The first is the need to improve the ability of medical insurance. The scope of protection of basic medical insurance has been continuously expanded, from the initial protection of only serious illnesses, to the current protection of insured residents' inpatient medical expenses at the same time, the insured residents' outpatient chronic disease medical expenses are also guaranteed, and the treatment guarantee is continuously extended and expanded to outpatient clinics; the level of protection has been steadily improved, and the number of drugs, medical service items and medical consumables that can be reimbursed within the scope of the policy has been increasing. 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 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. At the same time, the full implementation of resident critical illness insurance, covering all residents of the population insured by medical insurance, on the basis of basic medical insurance to provide further protection for high medical expenses, the required protection funds from the resident medical insurance financing according to a certain proportion or amount, do not need to pay additional premiums.

The second is to cope with the need for rising medical costs. With the rapid progress of medical technology, the gradual release of residents' medical needs, and the acceleration of population aging, the growth rate of total health expenditure has continued to be higher than the growth rate of GDP and per capita disposable income in recent years, and this trend is difficult to reverse for a long time, which has a great impact on the operation of the medical insurance system. From 2010 to 2022, the average annual growth rate of total health expenditure in the country was 12.8%, and the total health expenditure as a percentage of GDP increased from 4.84% to 7%. The average medical expenses for outpatient visits increased from 167 yuan to 343 yuan in 2022, and the average inpatient expenses increased from 6,194 yuan to 10,861 yuan (including employee medical insurance and resident medical insurance). The share of personal health expenditure in the country's total health expenditure dropped sharply from 55.8% in 2003 to 27.0% in 2022. In order to ensure the overall stability of the level of protection, the financing level of residents' medical insurance needs to be increased accordingly.

The third is for the sustainable development of the system. In the early days of the establishment of the system, the financing started from a low level, mainly with financial subsidies, and individuals only paid a small amount of fees, which effectively mobilized the enthusiasm of the masses to participate in insurance, but it was not sustainable in the long run. Residents need to pay for medical insurance, which is a requirement for the sharing of social insurance rights and obligations and financing responsibilities, and individuals bear certain payment responsibilities, which is conducive to enhancing the health management and cost saving awareness of the insured, so as to form a pattern of national payment and insurance, co-construction and sharing. In order to clarify the primary responsibility of individuals for their own health, while the state continues to increase financial investment, it is also necessary to simultaneously increase the level of individual contributions. For families and individuals in difficulty who are really burdened with heavy contributions, the state has also specially arranged financial funds to subsidize the participation in residents' medical insurance through the medical assistance system, which reflects the institutional attributes of basic medical insurance to help the weak and the poor.

Southern Weekly: How do you view the cost-effectiveness of individual medical insurance premiums?

National Health Insurance Administration: Let's take a look at a set of data first: in 2023, the total financing of financial subsidies and individual contributions for residents' medical insurance will be about 1 trillion yuan, accounting for 0.8% of GDP, and only 0.3% if you look at individual contributions. With the lowest level of financing in the world, the problem of protecting the health care costs of nearly 1 billion people has been solved. Although the individual payment standard for residents' medical insurance has risen, it has only increased by 370 yuan in the past 20 years, which is well adapted to the improvement of people's health awareness and the development of medical technology, as well as the increase in the number of people, frequency and cost of medical treatment.

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. That is, in the past 20 years, we only need to pay 0.46 yuan per day for medical insurance, you can get a government subsidy of 1.12 yuan, you can enjoy better medical security, you can exchange for physical health and the increase in life expectancy of residents from 72.26 years in 2003 to 78.2 years now, which is very worthwhile, China's resident medical insurance can be said to be the world's most cost-effective medical insurance.

According to the current financing standard of 1,020 yuan, if the medical expenses increase by 10%, then the financing standard will increase by at least 100 yuan per person, and we actually only increased by less than 30 yuan. Behind this is the continuous increase in financial security, which has played an important role in ensuring the stable growth and cost-effectiveness of everyone's treatment.

Southern Weekly: In the 14th Five-Year Plan for Universal Medical Security, it is clearly proposed to improve the financing policy for basic medical insurance for urban and rural residents, study the establishment of a mechanism to link payment with the level of economic and social development and the per capita disposable income of residents, and optimize the structure of individual payment and government subsidies. What progress is being made so far?

National Health Insurance Administration: At present, the medical insurance for urban and rural residents adopts fixed payment, and the fixed increase in residents' medical insurance payment is actually a manifestation of the income linkage, and the operating cost is relatively low, which is compatible with the current stage of reform and development. Although the growth rate of individual payment standards has been reported in recent years, the proportion of individual contributions in per capita disposable income has remained at about 1%. Residents' medical insurance financing has always been based on financial subsidies, supplemented by individual payments, and financial subsidies are the main source of medical insurance funds for urban and rural residents. The structure of individual payment and government subsidy has been in the process of continuous optimization, and the ratio of financial subsidy to individual payment has been gradually adjusted to 1.68:1, which is more reasonable.

In the future, with the enhancement of residents' insurance awareness, accurate identification of personal income and improvement of regional management capabilities, the financing policy of residents' medical insurance will be further optimized and improved, so that residents' medical insurance payment is more suitable for the level of economic and social development.

The cumulative balance of the resident medical insurance fund is at a reasonable and safe tight balance level

Southern Weekly: We have noticed that except for 2020, the expenditure of the residents' medical insurance fund has continued to increase in the past 10 years. What is the reason for this trend?

National Health Insurance Administration: Overall, the continuous growth of medical insurance fund expenditure for urban and rural residents in recent years is generally in line with the objective law of economic and social development, which is not only a concrete embodiment of the high-quality development of medical security, the continuous expansion of the scope of protection, and the continuous improvement of people's livelihood and well-being, but also the continuous rise in medical costs brought about by the development of new technologies, the continuous enhancement of medical security capabilities, the increase in the convenience of medical treatment for the masses, and the more convenient treatment in other places.

Southern Weekly: Financial subsidies have always been the main source of financing for residents' medical insurance, what is the current level of the cumulative balance of residents' medical insurance funds?

National Health Insurance Administration: The basic medical insurance for residents implements the "pay-as-you-go" system, and on the basis of ensuring the medical security needs of residents in the current year, a certain balance fund is retained to enhance the fund's ability to resist risks and ensure the long-term operation of the system. According to the 2023 fund statistical bulletin, the total income of the national basic medical insurance fund for urban and rural residents is 1,047.459 billion yuan, the total expenditure is 1,042.253 billion yuan, and the current balance of the overall fund at the end of the year is 5.206 billion yuan, with a cumulative balance of 764.749 billion yuan. On the whole, the cumulative balance of the medical insurance fund for mainland residents is at a reasonable and safe tight balance level, but due to the low level of financing and the difference in the level of economic development between regions, there are also some regional medical insurance funds with current deficits.

Southern Weekly: How does the NHSA resolve the risks of the operation of medical insurance funds in some of the regions mentioned above?

National Health Insurance Administration: First, continue to optimize the structure of residents' individual financing and financial subsidies, strengthen the management of the whole process of the fund, and prevent the misappropriation of funds; secondly, solidly promote the implementation of the "14th Five-Year Plan" for universal medical security requirements on improving the overall level of the fund, and steadily promote the overall planning at the provincial level on the basis of the basic realization of the national medical insurance fund at the municipal level. After the overall level is improved, the medical insurance fund can be adjusted and balanced in the city or province, improve the anti-risk ability of the medical insurance fund, and better play the role of medical insurance mutual aid; Thirdly, deepen the reform of medical insurance payment methods, improve the awareness of cost management of medical institutions and the efficiency of the use of medical insurance funds; finally, strengthen the normalized supervision of the use of medical insurance funds, and promote the formation of a high-pressure situation of medical insurance fund supervision and improve the efficiency of fund use through the combination of unannounced inspections, special rectification and daily supervision.

Various measures have been taken to increase the enthusiasm of urban and rural residents to participate in insurance

Southern Weekly: In addition to the issue of payment fees, some people believe that residents' medical insurance can only be used for hospitalization, not for outpatient treatment. What to make of such a view?

National Health Insurance Administration: In the early days of the establishment of resident medical insurance, it did give priority to ensuring hospitalization, but in recent years, with the improvement of the level of financing, the state has continuously improved the policy of residents' medical insurance treatment, improved the outpatient security mechanism, and continuously improved the outpatient security.

Since 2019, the mainland has established a guarantee mechanism for outpatient medication for hypertension and diabetes. From its establishment in 2019 to the end of 2023, a total of 180 million patients with hypertension and diabetes across the country have enjoyed outpatient drug protection treatment, with a reimbursement amount of 79.9 billion yuan, and the reimbursement ratio within the policy scope has reached the expected target of no less than 50%.

At present, general outpatient co-ordination and outpatient chronic disease and special disease protection are generally established throughout the country, and the reimbursement limit for outpatient clinics ranges from 200 to 500 yuan, and the degree of protection is higher in areas with good conditions. In 2022, 1.700 billion outpatient and emergency treatments and 297 million outpatient chronic diseases were enjoyed by residents participating in medical insurance, 2.03 outpatient treatments per capita were enjoyed by resident medical insurance participants, an increase of 0.12 times over the previous year, 62.2 billion yuan was paid by the general outpatient and emergency treatment of resident medical insurance, 103.6 billion yuan was paid by the outpatient chronic disease fund, and the average outpatient overall cost was 102 yuan and 515 yuan per outpatient chronic disease.

In addition, resident outpatient clinics can also enjoy remote medical services. It has basically realized the cross-provincial direct settlement of five outpatient chronic diseases, including hospitalization, general outpatient, hypertension, diabetes, outpatient radiotherapy and chemotherapy for malignant tumors, uremia dialysis, and rejection treatment after organ transplantation. In 2022, 14,052,200 residents received outpatient and emergency visits in other places, and 5,997,200 outpatient and serious illness settling cases, with a total outpatient and emergency expenses of 4.327 billion yuan and outpatient serious illness expenses of 13.306 billion yuan.

Southern Weekly: What other measures will the NHSA take to increase the enthusiasm of urban and rural residents to participate in insurance in the future?

National Health Insurance Administration: First, continue to do a good job in participating in insurance with residence permits, and guide megacities and megacities to do a good job in the participation of non-local household registration personnel in local basic medical insurance. The second is to consolidate and improve the level of medical insurance treatment and enhance the attractiveness of the system. The third is to support local governments to explore incentive and restraint measures to encourage the insured people to participate in insurance continuously. Fourth, strengthen departmental coordination, promote information sharing, realize the dynamic update of insurance data, and timely and accurately grasp the insurance situation of the masses. Fifth, it is necessary to provide diversified and convenient online and offline insurance payment services for the insured people, improve the service capacity of designated medical institutions and medical insurance public service institutions, continue to promote direct settlement of medical treatment across provinces and places, and explore the expansion of the scope of direct settlement of outpatient chronic diseases. Sixth, it is convenient for newborns, college students, flexible employment personnel and other people with frequent changes in insurance status to participate in insurance. Finally, it is necessary to consolidate and expand the results of universal insurance through comprehensive measures such as fine management, publicity and mobilization.

Southern Weekly reporter Haiyang Southern Weekly intern Wei Yaqi

Editor-in-charge: Cao Haidong