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According to the website of the National Health Insurance Administration, on July 25, the National Health Insurance Administration released the 2023 National Medical Security Development Statistical Bulletin.
In 2023, the National Health Insurance Administration will adhere to the guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, thoroughly study and implement the spirit of the 20th National Congress of the Communist Party of China, resolutely implement the decisions and arrangements of the Party Central Committee and the State Council, completely, accurately and comprehensively implement the new development concept, accelerate the construction of a new development pattern, continue to improve the medical security system with Chinese characteristics, improve the quality and efficiency of management services, and achieve overall stable operation of the medical insurance system, consolidate and improve the treatment of the masses, and operate the fund safely and sustainably.
First, the operation of basic medical insurance is safe and stable
By the end of 2023, 133389 million people will be insured by the national basic medical insurance (hereinafter referred to as basic medical insurance). In 2023, the total income of the national basic medical insurance (including maternity insurance) fund will be 3,350.136 billion yuan, the total expenditure of the national basic medical insurance (including maternity insurance) fund will be 2,820.838 billion yuan, and the current balance of the overall fund in 2023 will be 503.959 billion yuan, with a cumulative balance of 3,397.975 billion yuan.
(1) Basic medical insurance for employees
1. Number of insured persons. By the end of 2023, 370.95 million employees had participated in medical insurance, an increase of 8.52 million or 2.3% over the previous year, of which 270.99 million were employees, an increase of 1.9% over the previous year; There were 99.96 million retired employees, an increase of 3.7% over the previous year, and the on-the-job retirement ratio was 2.71.
2019-2023 employee medical insurance personnel structure
Unit: 10,000 people
The number of insured persons (including active employees and retirees) in enterprises, government institutions, flexible employment and other personnel (including active employees and retirees) was 243.67 million, 66.68 million and 60.6 million respectively. The number of employees insured by the combination of medical insurance and the single construction of the overall plan were 345.25 million and 25.69 million respectively.
2. Fund income and expenditure. In 2023, the income of the employee medical insurance fund (including maternity insurance) will be 2,293.165 billion yuan, an increase of 10.3% over the previous year. The expenditure of funds (including maternity insurance) was 1,775.073 billion yuan, an increase of 16.4 percent over the previous year. In 2023, the income of the employee medical insurance pooling fund (including maternity insurance) will be 1,658.030 billion yuan, an increase of 26.0% over the previous year; the expenditure of the overall fund (including maternity insurance) was 1,165.277 billion yuan, an increase of 21.9% over the previous year; The current balance of the overall fund (including maternity insurance) was 492.753 billion yuan, and the cumulative balance (including maternity insurance) was 2,631.605 billion yuan. In 2023, the income of the personal account of employees' medical insurance will be 635.135 billion yuan, the expenditure of the personal account will be 609.795 billion yuan, the current balance of the personal account will be 25.339 billion yuan, and the cumulative balance will be 1.395421 billion yuan.
3. Enjoyment of treatment. In 2023, the number of employees who enjoy the benefits of insured personnel will increase rapidly, reaching 2.53 billion, an increase of 20.2% over the previous year. Among them, there were 2.18 billion outpatient and emergency visits, 270 million outpatient chronic disease visits, and 80 million inpatient visits. In addition, 2.3 billion people purchased drugs from pharmacies.
From 2019 to 2023, the number of employees enjoying medical insurance benefits
Unit: 100 million person-times
In 2023, the hospitalization rate of employees insured by medical insurance will be 21.86%. Among them, the hospitalization rate of in-service employees was 11.93%, and the hospitalization rate of retirees was 49.02%. The average hospitalization cost was 12,175 yuan, of which the average hospitalization cost in tertiary, secondary, first-level and below medical institutions (including ungraded) was 14,586 yuan, 8,665 yuan and 6,310 yuan respectively. The average inpatient bed day was 9.8 days.
From 2019 to 2023, the average hospitalization cost and hospitalization of employee medical insurance
Unit: yuan, 10,000 person-times
In 2023, the total medical expenses of employees participating in medical insurance will be 1,987.979 billion yuan, an increase of 21.3% over the previous year, of which 1,740.848 billion yuan will be incurred in medical institutions and 247.131 billion yuan will be incurred in pharmacies. Among the expenses incurred by medical institutions, the medical expenses of in-service employees were 750.176 billion yuan, and the medical expenses of retirees were 990.671 billion yuan.
84.6% of the funds in the catalogue of hospitalization expenses of employee medical insurance, and 83.5%, 87.4% and 89.4% of the third-level, second-level, first-level and below medical institutions paid respectively.
(2) Basic medical insurance for urban and rural residents
1. Number of insured persons. By the end of 2023, 962.94 million people were covered by the basic medical insurance for urban and rural residents (hereinafter referred to as resident medical insurance).
2. Fund income and expenditure. In 2023, the income of the resident medical insurance fund will be 1,056.971 billion yuan, the expenditure will be 1,045.765 billion yuan, the current balance will be 11.206 billion yuan, and the cumulative balance will be 766.370 billion yuan.
Income and expenditure of resident medical insurance fund from 2019 to 2023
Unit: 100 million yuan
3. Enjoyment of treatment. In 2023, 2.61 billion people will be treated by those participating in resident medical insurance, an increase of 21.1% over the previous year. Among them, there were 2.08 billion outpatient and emergency visits, 340 million outpatient chronic disease visits, and 200 million inpatient visits. The average hospitalization cost was 7,674 yuan, of which the average hospitalization cost in tertiary, secondary, first-level and below medical institutions (including ungraded) was 12,765 yuan, 6,205 yuan and 2,943 yuan respectively. The hospitalization rate of residents under medical insurance was 20.7%, with an average of 8.8 days of hospitalization.
From 2019 to 2023, the number of residents enjoying medical insurance benefits
Unit: 100 million person-times
In 2023, the medical expenses of residents insured by medical insurance will be 1,958.156 billion yuan, of which 1,942.697 billion yuan will be spent in medical institutions and 15.459 billion yuan will be spent in pharmacies. This represents an increase of 19.4% over the previous year. 68.1% of the funds paid in the catalogue of hospitalization expenses of residents' medical insurance, and 63.2%, 72.4% and 80.8% of the third-, second-, first-level and below medical institutions paid by the third-, second-, first-level and below medical institutions, respectively.
From 2019 to 2023, the average hospitalization cost and hospitalization number of residents under medical insurance
Unit: yuan, 10,000 person-times
Second, the maternity insurance system continues to play its role as a guarantee
In 2023, 249.03 million people will participate in maternity insurance nationwide, an increase of 2.82 million over the previous year. From 2023 onwards, we will further standardize and unify the statistical caliber of maternity insurance benefits, include the number of prenatal examinations and family planning visits in the statistics of maternity insurance benefits, and enjoy 28.34 million maternity insurance benefits, an increase of 10.65 million over the previous year and an increase of 60.2% over the previous year. The expenditure of the maternity insurance fund was 117.723 billion yuan.
From 2019 to 2023, the number of people participating in maternity insurance and the number of people enjoying benefits
Unit: 10,000 people, 10,000 people
3. The function of medical assistance as a support for the bottom line has been continuously enhanced
In 2023, the national medical assistance expenditure will be 74.6 billion yuan, and the medical assistance fund will subsidize 80.2 million people[1] to participate in basic medical insurance, and 153.4 million outpatient and inpatient assistance will be implemented, with the national average of 1,241 yuan for inpatient assistance and 132 yuan for outpatient assistance. In 2023, the central government will allocate 29.7 billion yuan in subsidies for medical assistance.
The participation rate of low-income rural populations in the monitoring area has remained stable at more than 99 percent. Various comprehensive medical insurance assistance policies have benefited 186 million low-income rural people seeking medical treatment, reducing the burden of medical expenses on low-income rural people by 188.35 billion yuan.
[1] Excludes the number of insured persons subsidized by other departments.
Medical assistance expenditure and number of people subsidized from 2019 to 2023
Unit: 100 million yuan, 10,000 people
Fourth, the coordinated development and governance of the "three medicines" have achieved remarkable results
(1) List of medical insurance drugs
The National Catalogue of Drugs for Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance (2023) contains a total of 3,088 kinds of Western medicines and Chinese patent medicines, of which 1,698 are Western medicines, 1,390 are Chinese patent medicines, and 892 are Chinese herbal decoction pieces. In 2023, 126 new drugs will be included in the adjustment.
Western medicines and proprietary Chinese medicines included in the 2019-2023 edition of the National Medical Insurance Drug Catalogue
Unit: species
Since the establishment of the National Health Insurance Administration in 2018, it has carried out dynamic adjustment of the medical insurance drug list for six consecutive years, and a total of 744 drugs have been added to the scope of the catalog. In 2023, 240 million drug reimbursements will be negotiated during the agreement period, and nearly 230 billion yuan will be reduced for patients through negotiated price reductions and medical insurance reimbursements.
(2) Reform of medical insurance payment methods
By the end of 2023, 384 co-ordinated regions across the country have carried out DRG/DIP payment, of which 190 cities have implemented DRG payment, 192 cities have implemented DIP payment, and DRG and DIP payment have been carried out in Tianjin and Shanghai.
(3) Centralized procurement of pharmaceutical consumables
In 2023, the eighth and ninth batches of state-organized drug centralized procurement will be carried out, involving 80 kinds of drugs, with an average price reduction of 57%. The fourth batch of state-organized intraocular lens and sports medicine consumables were collected, with an average price reduction of 70%. Up to now, a total of nine batches of state-organized drug centralized procurement, covering 374 kinds of drugs, and four batches of state-organized high-value medical consumables, covering coronary stents, artificial joints, orthopedic spine consumables, intraocular lenses and sports medicine consumables.
(4) Governance of pharmaceutical prices
In 2023, we will start the governance of drug prices on the Internet, and carry out the standardization of unified drug price data and information on the Internet. Monitor the price and distribution of drugs on the national list of drugs in short supply and the national key monitoring list of clinically necessary drugs that are prone to shortage, extract 256 pieces of abnormally high prices and 182 pieces of abnormal distribution information, and urge enterprises to take the initiative to correct abnormally high prices 275 times. Strengthen the normalized management and supervision of drug prices, interview 23 relevant pharmaceutical companies, involving 30 varieties, and the average price reduction of drugs interviewed exceeds 40%. Promote the pilot reform of medical service prices in an orderly manner, and guide the five pilot cities to carry out the first round of price adjustments. Steadily speed up the dynamic adjustment of medical service prices, and guide 28 qualified provinces to carry out price adjustments. Guide the provincial medical insurance bureaus to speed up the review of new medical service price items, and the total number of new medical service price items in various provinces has reached more than 1,900 throughout the year.
Fifth, the number of people seeking medical treatment in other places continues to increase
In 2023, there will be 243 million outpatient and emergency, outpatient chronic disease and inpatient medical treatment in other places across the country, of which 161 million people will receive medical treatment in other places for employee medical insurance (including 101 million people in the province and 60 million people outside the province), and 82.1436 million people will receive medical treatment in other places (including 51.9678 million people in the province and 30.1758 million people outside the province). The national expenses for outpatient and emergency, outpatient chronic diseases and inpatient medical treatment in other places were 711.105 billion yuan, of which 280.651 billion yuan were spent on non-local medical treatment by employee medical insurance and 430.454 billion yuan were spent on non-local medical treatment by residents.
From 2019 to 2023, the number of people seeking medical treatment in other places and the cost of medical treatment in China
Unit: 10,000 person-times, 100 million yuan
Sixth, the supervision of medical insurance funds is more powerful
In 2023, the national medical insurance system will inspect a total of 802,000 designated medical institutions, deal with 451,000 institutions that violate laws and regulations, of which 4,176 will terminate medical insurance service agreements, 20,586 will be administratively punished, and 367 will be handed over to judicial organs, and 32,690 people will be dealt with for violations of laws and regulations, of which 4,883 will be suspended from online settlement of medical expenses and 1,399 will be transferred to judicial organs. In 2023, 18.65 billion yuan of medical insurance funds will be recovered. In 2023, the National Health Insurance Administration will organize 34 groups of unannounced inspections, inspect 66 designated medical institutions and 32 medical insurance agencies, and find 920 million yuan of suspected illegal funds.
In the inspected medical institutions, 13.407 billion yuan of rejected payment and recovered funds were handled through agreements, and 1.447 billion yuan of liquidated damages were collected. The refusal or recovery of funds involved 198,700 designated medical institutions.
7. The pilot project of long-term care insurance has been steadily advanced
In 2023, a total of 183,308,700 people will participate in long-term care insurance in 49 pilot cities, and 1,342,900 people will enjoy benefits. In 2023, the fund income will be 24.363 billion yuan, and the fund expenditure will be 11.856 billion yuan. There are 8,080 designated service institutions for long-term care insurance, with 302,800 nursing service personnel.
The number of people participating in long-term care insurance and the number of people enjoying benefits from 2020 to 2023
Unit: 10,000 people
Income and expenditure of long-term care insurance fund from 2020 to 2023
Unit: 100 million yuan
Note: Some of the data in this bulletin are slightly different from the sub-totals due to rounding.
Editor: Liu Rui