Health insurance in China
Health insurance in China in 2019 was the fastest-growing category in the insurance industry in China. Health premiums rose by 23% in the first 10 months of 2018. It is expected that health premiums will reach an all-time high of CN¥539 billion (US$81.47 billion) for the year.[needs update] Ping An Insurance, the China Life Insurance Company, New China Life Insurance and China Pacific Insurance Company are the biggest players with 42% total market share in 2017. Out-of-pocket expenses are around a third of the total Chinese health spending.[1]
History
New Rural Co-operative Medical Scheme (2002–present)
As the old Rural Co-operative Medical Scheme (RCMS) ended, the need for affordable healthcare became urgent in
NRCMS is a voluntary insurance scheme subsidized by local and central government. NRCMS differs from RCMS in the following perspectives: Administration and
The World Health Organization (WHO) summarized the success of NRCMS: the NRCMS rapidly expanded, with an increasing service bundle. It provided better access to higher quality service, and partly controlled medical costs. NRCMS is appropriate and convenient for China's enormous number of migrant workers who used to have limited access to healthcare.[4] In 2015, NRCMS spent CN¥293.34 billion (US$45 billion) on 670 million participants and 1.653 billion instances of medical service, with the average of CN¥437.8 (US$67.25) per capita.[9]
However, there are some difficulties that undermine the scheme's effectiveness in reducing out-of-pocket medical costs. To begin with, the benefit package of NRCMS is mostly limited to
Urban Employee Basic Medical Insurance (1999–present)
Before 1978, urban residents are covered by Labor Insurance and Government Insurance which demanded small out-of-pocket payments. After then
In 1998, Urban Employee Basic Medical Insurance (UEBMI) was introduced to provide healthcare access to urban working and retired employees in public and private sectors as well. The UEBMI is administered at municipal level, higher than NRCMS. The UEBMI is funded by 8% deductions from employees' wages; of which 6% are paid by employers and 2% by employees,[17] however these rates can vary by municipality. It differs from other types of insurance schemes in that UEBMI is mandatory. In 2014, roughly 283 million were enrolled, contributing CN¥80.3 billion, CN¥283.74 per capita (US$12.97 billion in total, US$45.83 per capita), with an expenditure of CN¥66.9 billion, CN¥236.4 per capita (US$10.8 billion in total, US$38.19 per capita).[9]
Urban Residents Basic Medical Insurance (2007–present)
In 2007, Urban Residents Basic Medical Insurance (URBMI) started to provide healthcare access to urban residents that are not covered by UEBMI: children, students in schools, colleges and universities and other non-working urban residents.[18] URBMI was firstly piloted in 2007, and became nationwide in 2010. In 2015, 376 million urban residents (over 95%)[19] took part in URBMI.
URBMI is a government-subsidized, household-level voluntary medical insurance, administered at municipal level. The URBMI is funded mainly on individual contributions (CN¥245 for adults; 2008 pilot), and partly government contributions (at least CN¥80 per capita). Additional government contributions are given to undeveloped central and western regions, and poor or disabled individuals.[10] Research showed that URBMI helped improve healthcare utilization and residents' health conditions, especially for low-income residents.[20][21] Studies also suggested that URBMI was a step towards a universal healthcare system.[22]
References
- ^ "Wealthy Chinese spur booming $78bn health insurance industry". Financial Times. 8 January 2019. Retrieved 15 February 2019.
- S2CID 153656512.
- ^ Dib, Hassan H., Pan, Xilong, and Zhang, Han. (2008). Evaluation of the new rural cooperative medical system in China: is it working or not? International Journal for Equity of Health, 7–17.
- ^ PMID 24940019.
- OCLC 276910548.
- PMID 27025430.
- ^ Wagstaff, Adam, Magnus, Jun, Gao, Ling, Xu, and Juncheng, Qian. (2009). Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme. Journal of Health Economics, 1, 1–19
- ISSN 1758-5899.
- ^ ISBN 9787567906433.
- ^ PMID 22095892.
- PMID 10162419.
- S2CID 2844047.
- PMID 20219278.
- ^ Cheng, Lingguo (2012). "NRCMS: Economic Effects or Health Effects?". Economic Research Journal. 01: 120–133 – via CNKI.
- ^ Fang, Liming (2006). "Breaking Voluntary Puzzles: Incentives and sustainable development in NRCMS". China Rural Survey. 4: 24–32+79 – via CNKI.
- ^ China State Council, Ministry of Health (March 5, 1997). "Decision on Healthcare Reform and Development".
- ^ China, State Council (1998). "Decision on establishing Urban Employee Basic Medical Insurance". gov.cn.
- ^ State Council, China (2007). "Guidelines on Urban Residents Basic Medical Insurance Pilots". gov.cn.
- ^ "Enrollment Rate for Three Basic Medical Insurance was More than 95% in 2014". cnr.cn.
- ^ Pan, Jie (2013). "Is Medical Insurance Improving Health? Empirical analysis based on URBMI". Economic Research Journal. 4 – via CNKI.
- .
- PMID 19551750.