In 2018, under the strong leadership of CPC Central Committee with comrade Xi Jinping as the core, the national medical system kept to the Xi Jinping Thought on Socialism with Chinese characteristics for a New Era as a guide, fully implemented the spirits of the 19th National Congress of the Communist Party of China and the Second and Third Plenary Session of the 19th Central Committee, in accordance with the decisions and plans of the CPC Central Committee and the State Council, we kept our mission firmly in mind and made solid progress in reform, made steady progress in integrating the medical insurance system of the urban and rural areas, and continued to deepen reform of the payment way of medical insurance, constantly improved the systems of serious illness insurance and medical assistance, strengthened supervision of medical insurance fund, carried out medical treatment by doctors from other places in an orderly manner, and significantly improved the capacity of basic medical care.
I. Medical Insurance
In 2018, there were 1.34459 billion people participating in the national basic medical insurance[1] (hereinafter referred to as the “basic health insurance”), the rate of insurance remained above 95%, and the health insurance of coverage of personnel had been realized. In 2018, (1) the total revenue of the national basic medical insurance funds was of CNY 2.1384 trillion, an increase of 19.3% over the previous year, and accounting for about 2.4% of the GDP of the year; (2) the total expenditure of the national basic medical insurance funds reached CNY 1,782.2 billion, an increase of 23.6% over the previous year, accounting for about 2.0% of the GDP of the year; (3) the accumulative total balance of the national basic medical insurance funds reached CNY 2.344 trillion including the pooling funds of CNY 1.615.6 trillion in the basic medical insurance and personal accounts of CNY 728.4 billion in basic medical insurance of employee (hereinafter referred to as “medical insurance of employees”).
(1) Basic medical insurance of employees
1. The number of the insured continued to increase. In 2018, there were 316.81 million people participating in the medical insurance of employees, an increase of 4.5% over the previous year. Among them, 233.08 million were employed, an increase of 4.6% over the previous year. The number of retired workers reached 83.73 million, an increase of 4.2% over the previous year. The ratio of on-job retirement was 2.78, up slightly on year-on-year basis.
The number of people participating in the insurance scheme (including on-job employees and retirees) in enterprises, organs and institutions, flexible employment and other types of personnel, was 215.2 million, 61.19 million and 40.42 million, respectively, with an increase of 8.87 million, 1.59 million and 3.12 million over the previous year, accounting for 67.9%, 19.3% and 12.8% of the total insured population, respectively, which were basically unchanged from the previous year. There were 29,001 million workers covered by social pooling combined with the individual accounts of medical insurance system and 26.8 million insured personnel of single building to plan as a whole, accounting for 91.5% and 8.5% of the total number of insured workers, respectively.
2. Income and expenses of funds were expanded. In 2018, the fund income medical insurance of employee was CNY 1.3538 trillion, an increase of 10.3% over the previous year. The fund expenditure was CNY of 1.0707 trillion, an increase of 13.1% over the previous year. In 2018, the funds-collecting rate of medical insurance of employee was 99.4%, flat over the previous year; and the income of funds collection was CNY 1.2935 trillion, accounting for 95.5% of the fund income and ratio for more than 2.7% higher than the previous year. (1) In 2018, the pooling fund income of the medical insurance of employee was CNY 82.41 billion, an increase of 7.8% over the previous year; (2) the fund expenditure was CNY 64.94 billion, an increase of 12.7% over the previous year; and (3) the balance of current period was CNY 17.47 billion, and the accumulative total balance was CNY 1.1466 billion. (1)In 2018, the individual account income of the medical insurance of employee was CNY 52.97 billion, an increase of 14.3% over the previous year; (2) the individual account expenditure was CNY 42.12 billion, an increase of 13.7% over the previous year; and (3) the accumulative of current period was CNY 10.84 billion, and the cumulative accumulation was CNY 72.84 billion.
3. The number of people enjoying treatment increased. In 2018, there were 1.98 billion people (person-time) enjoyed the treatment of medical insurance of employees, an increase of 9.0% over the previous year, an increase of 3.0%. Among them: (1) 1.71 billion people (person-time) visited the general outpatient and emergency treatment, an increase of 8.8% over the previous year; (2) 210 million people (person-time) visited the outpatient for chronic diseases, an increase of 12.7% over the previous year; and (3) the number of hospitalizations reached 0.6 million (person-time), an increase of 6.7% over the previous year.
In 2018, the per capita visited the doctor of the insured of medical insurance employees was 6.2 times, an increase of 0.3 times over the previous year; and hospitalization rates was 18.3%, an increase of 0.4% over the previous year. Among them: the hospitalization rate of on-job employees was 9.7%, an increase of 0.2 percentage points over the previous year; and the hospitalization rate of retirees was 42.1%, an increase of 0.9 percentage points over the previous year.
4. The choice of medical treatment continued to tend to the tertiary hospitals. In 2018, the insured of medical insurance of employees hospitalizing in level 3, level 2 and level 1 and below medical institutions were respectively 30.84 million, 18.29 million, 7.24 million, an increase of 9.7%, 3.8% and 1.9%, respectively, accounting for 54.7%, 32.5% and 12.8% of total number of inpatients. In 2018, the treatment person-times of the general outpatient of the national medical insurance employee under the distribution of the level 3, level 2 and level 1 and below medical institutions were 33.3%, 22.5% and 44.2%, respectively, compared with last year accounted for separately increased by 1.8%, reduced 1.1% and 0.7%. In 2018, the treatment person-times of the outpatients for chronic diseases of the national medical insurance employees under the distribution of the level 3, level 2 and level 1 and below medical institutions were 47.6%, 27.1% and 25.3%, respectively, compared with last year separately increased by 0.2%, reduced 0.5% and increased 0.3%.
5. The level of hospitalization reimbursement was stable and slightly increased. The hospitalization expenses within the scope of medical insurance policy for employees were paid by fund: 81.6%, basically unchanged with the previous year. Of this amount, (1) 79.7% was paid from pooling fund, an increase of 0.4% over the previous year; (2) the actual payment of hospitalization expenses from the fund was 71.8%, including 70.1% from the pooling fund, an increase of 0.2% over the previous year; (3) and the personal burden was 28.2%. The fund for hospitalization expenses within the scope of medical institutions policy at or below the secondary level was 84.0%, which was the same as the previous year and exceeded 3.5% for medical institutions at the level 3.
5. The level of hospitalization reimbursement was stable and slightly increased. The hospitalization expenses within the scope of medical insurance policy for employees were paid by fund: 81.6%, basically unchanged with the previous year. Of this amount, (1) 79.7% was paid from pooling fund, an increase of 0.4% over the previous year; (2) the actual payment of hospitalization expenses from the fund was 71.8%, including 70.1% from the pooling fund, an increase of 0.2% over the previous year; (3) and the personal burden was 28.2%. The fund for hospitalization expenses within the scope of medical institutions policy at or below the secondary level was 84.0%, which was the same as the previous year and exceeded 3.5% for medical institutions at the level 3.
The inpatient expenses of medical institutions at the level 3, level 2 and level 1 and below medical institutions were CNY 436.3 billion, CNY 153.3 billion, and CNY 40.8 billion, respectively, an increase of 10.2%, 4.8%, and 4.3% over the previous year, accounting for 69.2%, 24.3%, and 6.5% of the inpatient expenses, respectively, and an increase of 1.1%, a decrease of 0.9%, and a decrease of 0.2% over the previous year.
(II) Basic medical insurance for urban and rural residents
1. The number of the insured continued to increase. In 2018, there were 897.36 million people participating in the basic medical insurance of the national urban and rural residents (hereinafter referred to as the “residents medical insurance”), an increase of 2.7% over the previous year. Among them, there were 662.86 million adults, 213.68 million children and 20.82 million college students, respectively an increase of 2.7%, 3.7% and -4.7% over the previous year, accounting for 73.9%, 23.8% and 2.3% of the total insured people.
2. Income and expenses of funds were continuously expanded. In 2018, the fund income of resident medical insurance was CNY 697.1 billion, and expenditure was CNY 627.7 billion, an increase of 23.3% and 26.7% over the previous year, respectively,[4]. In 2018, the balance of current period of residents medical insurance fund was CNY 69.46 billion, and the cumulative total balance was CNY 437.23 billion.
In 2018, the per capita financing of the residents medical insurance was CNY 693, an increase of CNY 88 over the previous year, up by 14.5%; and the per capita fiscal subsidies was CNY 497, an increase of CNY 58 over the previous year, up by 13.2% [5].
3. The number of people receiving treatment person-times and medical expenses continued to increase. In 2018, the total enjoy treatment of residents covered by medical insurance was 1.62 billion person-times, an increase of 8.4% over the previous year. The per capita resident covered by medical insurance enjoyed 1.7 times of outpatient treatment, basically the same as the previous year. In 2018, the medical costs of the resident medical insurance was CNY 1.0613 trillion, an increase of 20.5% over the previous year; and the per capita medical expense was CNY 1183, an increase of 17.2% over the previous year.
4. Hospitalization rates and average hospitalization costs were increased. (1) The hospitalization rate of residents covered by medical insurance was 15.2%, an increase of 1.1% over the previous year; (2) the average length of hospitalization was 9.3 days, which was the same as the previous year; (3) and the average hospitalization cost was CNY 6,577, up 7.8% over the previous year. Among them, the average hospitalization cost was CNY 11,369, CNY 5,877 and CNY 3,145 in the medical institutions of level 3, level 2 and level 1 and lower medical institution, which increased by 11.3%, 6.1% and 0.9% respectively over the previous year.
5. The actual payment ratio of the fund increased slightly. Within the scope of the residents’ medical insurance policy, 65.6% of hospitalization expenses were paid by fund; while 56.1% of actual hospitalization expenses were paid by fund, an increase of 0.1% over the previous year; and the individual burden ratio was 43.9%, which was 0.1% lower than the previous year. According to the classification of medical institutions, within the scope of policy, the hospitalization expenses paid by fund could be divided into: level 3: 59.3%; level 2: 69.1%; and level 1 and below: 76.2%. Furthermore, the payment ratio (71.0%) of the medical institutions (level 2 and below) is 11.7% higher than that of the level 3 ones.
(III) New rural co-operative medical system
In 2018, seven provinces have implemented the new rural co-operative medical insurance system, including Liaoning, Jilin, Anhui, Hainan, Guizhou, Shaanxi, and Tibet. The number of the insured: 130 million, fund revenue: CNY 87.5 billion, fund expenditure: CNY 83.9 billion, and accumulative total balance: CNY 31.8 billion.
II. Maternity Insurance
In 2018, a total of 204.34 million people participated in maternity insurance programs nationwide, an increase of 5.9% over the previous year. (1) The fund revenue from the maternity insurance was CNY 78.11 billion, an increase of 21.6% over the previous year; (2) the fund expenditure was CNY 76.24 billion, an increase of 2.5% over the previous year; and (3) the balance of current period was CNY 1.87 billion, and the accumulative total balance was CNY 58.17 billion.
III. Medical Assistance
In 2018, fund expenditure for national medical assistance was CNY 42.46 billion, subsidized 76.739 million people to participate in basic medical insurance programs, and provided outpatient and inpatient assistance to 53.61 million people. The average amount of hospitalization assistance and outpatient assistance reached CNY 1,511 and CNY 106 respectively nationwide.
IV. Hospitalization in Other Places
In 2018, the hospitalization in other places [6] of the insured employees of medical insurance reached 36.56 million person-times, and the expenses for the hospitalization in other places were CNY 108.5 billion. Among them, (1) the hospitalization expenses were CNY 97.1 billion, accounting for 15.4% of the hospitalization expenses of the insured employees of medical insurance; and (2) the average hospitalization expense was CNY 17,670, which was 1.6 times of the average hospitalization expenses for the insured employees of medical insurance.
In 2018, the hospitalization in other places of the insured residents of medical insurance reached 28.76 million person-times, and the expenses for the hospitalization in other places were CNY 196.5 billion. Among them, (1) the hospitalization expenses were CNY 190.6 billion, accounting for 21.2% of the hospitalization expenses of the insured residents of medical insurance; and (2) the average hospitalization expense was CNY 14,016, which was 2.1 times of the average hospitalization expenses for the insured residents of medical insurance.
By the end of 2018, there were 15,000 designated medical institutions (trans-provincial) for the hospitalization in other places nationwide, and the designated medical institutions, which have more than 500 inpatients (trans-provincial), were all connected to the settlement platform of the hospitalization in other places, and the county-level administrative districts basically achieved full coverage. In 2018, the direct settlement of hospitalization expenses for the hospitalization in other places (trans-provincial) reached 1.32 million person-times, which was 6.3 times that of 2017.
V. Drug Access Negotiations and Centralized Procurement
Specialized negotiations on the medical insurance access of anti-cancer drugs were carried out, and 17 drugs were included in the medical insurance catalogue, with an average reduction of 56.7%, which was significantly lower than the prices of neighboring countries and regions, with an average decrease of 36%. Payment standards of medical insurance on 14 anti-cancer drugs undergoing national negotiations at the early stage have been adjusted, with an average decrease of 4.9%.
The provincial-level special centralized procurement of anti-cancer drugs was carried out, and the price of 69 anti-cancer drugs was reduced, with an average decrease of 10%. The price survey was conducted for drugs (their purchase price is higher and the difference of their price is larger in different provinces). The price of 15 anti-cancer drugs was reduced by 10.3% voluntarily, and the average inter-provincial ratio of difference in price decreased from 24.7% to less than 10%.
The pilot project for centralized drug procurement of the state was carried out, to concentrate the part medicine dosage in public medical institutions in four municipalities and seven sub-provincial cities, and to select the generic names corresponding to generic drugs passing the consistency assessment. In addition, under the premise of insisting on quality and ensuring supply, adopt the centralized special quantity procurement to realize the price adjustment with quantity. In the pilot project, 25 varieties were selected. Compared with the minimum purchase price of the same drug in the pilot city in 2017, the price of selected varieties had an average decrease of 52%, with the highest decrease of 96%. The procurement cost of drugs for the corresponding varieties in 11 cities was expected to fall from CNY 7.7 billion to CNY 1.9 billion.
V. Fund Supervision
In 2018, during the special action against fraudulent gaining of medical insurance fund, a total of 197,000 designated medical institutions and retail pharmacies nationwide were inspected, and 66,000 designated medical institutions in violation of laws and regulations were investigated and dealt with, accounting for about one-third of the spot-checking institutions, and accounting for one ninth of all designated medical institutions, of which 1,284 designated medical institutions were dismissed from the medical insurance agreement, 127 ones were transferred to the judiciary, and 24,000 insured persons in violation of the laws and regulations were investigated and dealt with.
Established a reward system for reporting for insurance bilk, opened a report and complaint phone and WeChat reporting channel, and strengthened the supervision of the masses and the society. In 2018, the National Healthcare Security Administration received 4,444 reports including telephone, WeChat official account, and letter reports, of which 739 reports were effective.
VII. Poverty Alleviation of Medical Insurance
Taking the targeted poverty alleviation of medical insurance as one of the main battlefields for poverty alleviation, we will do our best to implement them. Formulated and issued the “Three-Year Action Plan for Poverty Alleviation of Medical Insurance”, to clarify the six goals and five major measures for the targeted poverty alleviation of medical insurance, and standardize the poverty alleviation policies of local medical insurance. In addition, cooperated with the Ministry of Finance to further increase the financial subsidies for poverty alleviation of medical insurance. Since 2018, the central government has increased the medical aid subsidy of CNY 8 billion for two consecutive years to further support the deep poverty-stricken areas to improve the medical care level of the rural poor population. In 2018, compared with the previous year, the number of people living in poverty (caused by diseases) in the “three districts and three prefectures” (Tibet, Tibetan areas in four provinces, four districts in Southern Xinjiang, Liangshan Prefecture in Sichuan, Nujiang Prefecture in Yunnan, and Linxia Prefecture in Gansu) decreased by 163,000; while the number of people living in poverty (caused by diseases) in other deep poverty-stricken areas decreased by 1.093 million.
Source: National Healthcare Security Administration