As a key part of social security, medical insurance has a direct impact on the quality of citizens' lives, and is a social welfare undertaking with extensive influence and far-reaching significance. Based on this background, the mainland has formulated three pillar policies, including basic medical insurance, serious illness insurance, and medical assistance, and has built a comprehensive medical security system.
1. Basic medical insurance: the "basic plate" for maintaining people's health
In China, whether you are an urban resident or a rural person, you can enjoy the protection of basic medical insurance. This universal coverage system is divided into employee medical insurance, which mainly covers the working population, and resident medical insurance, which mainly covers the non-employed population.
Today, the types of drugs covered by basic medical insurance have expanded from more than 300 in 2003 to 3,088 in 2022, covering more than 90% of the drug amount in public medical institutions, covering 74 types of anti-tumor drugs and more than 80 drugs for the treatment of rare diseases. This ever-growing "base bank" guards the health and well-being of ordinary people.
In addition, with the popularization and development of information technology, medical insurance is also improving. New methods such as electronic medical insurance cards, Internet settlement, and remote medical treatment are constantly emerging, making medical insurance services closer to people's livelihood and more convenient.
At the same time, many new medical items are also included in the scope of reimbursement, such as color ultrasound, CT, MRI and other examinations, as well as painless and minimally invasive surgery, etc., providing a broader platform for medical services.
2. Critical illness insurance: building a healthy "firewall"
Compared with the smooth coverage of basic medical insurance, critical illness insurance is more like a towering "firewall", providing a higher level of protection for policyholders facing the risk of critical illness.
At present, the proportion of critical illness insurance payment for urban and rural residents in mainland China is not less than 60%, and the proportion of payment will be increased by another 5 percentage points for low-income families, extremely poor individuals, and groups that have returned to poverty due to illness or are newly impoverished, and the maximum payment ceiling will be further raised.
In 2023, the critical illness insurance for urban and rural residents in China will benefit a total of 11.56 million people, reducing the burden of 8,000 yuan per person on average. Behind the critical illness insurance, it means a higher reimbursement ratio and stronger protection ability.
Take Shenzhen as an example:
On September 7, 2023, the Shenzhen Municipal Health Insurance Bureau issued the "Shenzhen Medical Security Measures", which will change the original supplementary medical insurance to serious illness insurance from October 1, 2023. According to the new policy, both employee medical insurance and urban and rural residents can enjoy the benefits of critical illness insurance without paying additional fees.
Critical illness insurance will pay the basic medical expenses of specific diseases in inpatient and outpatient clinics twice, with a minimum payment line of 10,000 yuan, and the payment ratio is set in stages, which is 70% and 80%.
At the same time, according to the continuous participation in basic medical insurance, the annual payment limit has also been adjusted, up to 1 million yuan. In addition, the treatment of serious illness insurance is tilted towards medical assistance recipients, the minimum payment line is reduced from 10,000 yuan to 2,000 yuan, the payment ratio is increased by 10 percentage points, and the maximum payment limit is abolished.
It can be said that the government has given full play to the core values of socialism, promoted the spirit of humanitarianism, and achieved full humane care and social equity in the medical insurance system.
III. Medical Assistance: Building a Guaranteed "Bottom Line"
If basic medical insurance is regarded as a necessary choice for the insured's daily life, and critical illness insurance is a strong support in the face of critical illness, then medical assistance is a kind of medical assistance and a "back-up network" with wide coverage and basic protection.
In November 2021, the General Office of the State Council issued the "Opinions on Improving the Medical Insurance and Assistance System for Serious and Serious Diseases", which made systematic arrangements for the medical security system. The Opinions mainly include provisions on the expansion and optimization of the scope of assistance recipients, the subsidy for insurance, the scope of protection of assistance expenses, the setting of minimum payment standards, the proportion of assistance and preferential policies.
The first is to expand the scope of assistance recipients, extending from income-based poverty to expenditure-based poverty, and carrying out classified management and optimizing classification according to the degree of difficulty, medical expense burden, etc., and the opinions continue to expand the scope of assistance objects.
Secondly, in terms of subsidy and insurance, the extremely poor will be fully subsidized, and the subsistence allowance recipients, the people who have returned to poverty and other difficult groups will be subsidized in a fixed amount, and the provincial government will determine the fixed subsidy standard according to the actual situation.
In addition, the coverage of assistance expenses mainly covers hospitalization expenses, long-term medication costs and long-term outpatient treatment expenses, and the expenses paid by the medical assistance fund shall comply with the relevant national regulations on the scope of payment of the basic medical insurance fund. The minimum payment standard implements categorical and sub-level assistance, and sets different minimum payment standards according to different assistance recipients.
More help will be provided to those who are referred by a standard and are treated in the province, and after being protected by the three-tier insurance system, the individual still bears the higher cost within the policy coverage.
As for the funding source of the medical relief fund, it mainly relies on various channels such as financial subsidies from local and central governments, lotteries and public welfare funds, and social donations.
It can be seen that medical assistance has played an extensive and important role in helping vulnerable groups in society such as people living in extreme poverty and subsistence allowance recipients to resist the risk of disease.