Exploration and Prospect of China Exploration and Prospect of China medical security system reformmedical security system reform

Zhang Xiaojie Sociology department of SAI

2014.6

2

Backgrounds Health care reform is a worldwide

problem, China is also plagued by this problem

China's health care system in medical service supply mechanism and medical management made a lot of exploration

Marketization of medical security and medical service is the core issue of health care reform

3Main content

Exploration of China's medical security system reform

Current problems

Prospects33

22

11

41. Exploration

Reform process1.1

The first stage (1951-1984) : Free medicare ；The second stage (1984-1997) : a market-oriented health care reforms；The third stage (1997-2009) : the marketization of medical treatment and problems；The fourth stage (2009 - present) : the new health care reform and comprehensively deepen market-oriented reform

51. Exploration

Reform processThe new health care reform:From 2009 to 2011: Universal coverage of basic medical insurance; National essential drug-list system; Basic medical and health service system; Universal access to basic public health services; Trial reform of public hospitals;

By 2020, the establishment of basic medical and health system covering both urban and rural residents, everyone will have access to basic medical and health services

1.1

6

．20092007．2002．1998．．1996．

．1994．．

．

197819601953．．19501949

．20092007．2002．1998．．1996．

．1994．．

．

197819601953．．19501949 The planned

economy

The planned economy

Free medicare systemFree medicare system

Labor medicare systemLabor medicare system

Rural cooperative medical systemRural cooperative medical system

Two pilotsTwo pilotsMarket economy

Market economy

Expansion of trialsExpansion of trials

Medical insurance for urban workersMedical insurance for urban workers

New Rural Co-operative Medical SystemNew Rural Co-operative Medical SystemMedical insurance for urban residentsMedical insurance for urban residents

Universal health care systemUniversal health care system

1. Exploration

71. Exploration

Medical assistance systemMedical assistance system

New Rural Co-operative Medical System

Basic medical

insurance for urban workers

Medical Medical insurance insurance for urban for urban residentsresidents

Civil Civil servservantsants

Large Large medicaidmedicaid

enterpriseenterprise

Commercial health insuranceCommercial health insurance

Foudation

Man body

Supplement

Rural Rural populationpopulation

Urban Urban populationpopulation

Present framework

8

Development of the medical security system

1. Exploration

Form Coverage Ratio Security level

MIU-W 2.65 billion

1/3 （ In urban population）

High, but some people only for a serious illness

NCMS 8.02 billion

A complete coverage

Basic only serious illness , actual reimbursement ratio is about 30%

MIU-R 2.72 billion

50% of the city reimbursement ratio slightly higher than the

NCMS

MAS 0.22 billion

symbolic system

Expanding coverage

1.2

9

Development of the medical security system

1. Exploration

2006 2007 2008 2009 2010 2011 2012

　 　 　 　 　 　 　 　

Number(billion) 4.10 7.26 8.15 8.33 8.36 8.32 8.05

Rate (%) 80.7 86.2 91.5 94.2 96.0 97.5 98.3

Per capita financing(RMB) 52.1 58.9 96.3 113.4 156.6 246.2 308.5

fund expenditure(billion RMB)

155.8 346.6 662.3 922.9 1187.8 1710.2 2408.0

Benefit people(billion)

2.72 4.53 5.85 7.59 10.87 13.15 17.45

NCMS

1.2

10

Development of the medical security system

1. Exploration

3786. 9

7285. 9

9401. 210901. 7

12403. 613782. 9

15731. 8

18020. 0

19995. 6

21937. 4

23734. 725227. 1

26485. 6

0. 0

5000. 0

10000. 0

15000. 0

20000. 0

25000. 0

30000. 0

2000年 2001年 2002年 2003年 2004年 2005年 2006年 2007年 2008年 2009年 2010年 2011年 2012年

MIU-W

1.2

112. Current problems

Fragmentation and differentiation of medical security system2.1

Fragmentation ： Division of urban and rural system, Separation of management system, four different kinds of medical insurance system coexist

differentiation ： According to the different types of health care, the security level gap is obvious

Medical insurance plan as a whole level mainly stays in the county, the management of the medical insurance and reimbursement process is very complicated.

122. Current problems

Expensive and difficult

The medical service market dominated by the supplier, medical costs rising too fast

Too much personal cash payments, insurance payment proportion is too low

Most of the urban and rural residents depend mainly on personal and family power to resist disease risk, low population could enjoy medical insurance

2.2

13

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Government health expenditure

Social health expenditure

Personal expenses

20.4%

45.2%

47.4%

34.5%

32.2% 20.3

%

数据来源：中华人民共和国卫生部： «2008中国卫生统计年鉴 » ， 2009年卫生部报告

The proportion of medical expenses

14Type Number (billion)

Rate (%) Per capita health

expenditure (RMB)

Per capita insurance

(income) (RMB)

The proportion of insuran

ce cost %

MIU-W 2.1 16% 1,337 970

（ 1,293）72%

MIU-R 1 8% 1,337 170

(200)

13%

NCMS 8.1 61% 565 85

(100)

15%

No insurance (inc

luding free medic

al care)

2.1 16% 920 0 0

Total 13.3 100% 920

152. Current problems

Medical insurance institutions did not play the role of third party supervision

Health insurance is merely act as the role of the third

party payment

As the largest buyer of medical treatment insurance,

who was not involved in the whole process of medical

services and medical service cost price formation.

2.3

162. Current problems

Major differences still exist in the reform

The "general health" can be regarded as private consumption goods?

The focus of the medical security is confirmed a serious illness or common disease and frequently-occurring disease?

The financing mode of medical security should choose insurance, or fiscal budget?

The government subsidies suppliers or the demand side?

Medical service resources configuration can rely mainly on the market?

Medical service institutions can give priority to with the for-profit sector?

How to protect the interests of the medical staff and how to implement incentive?

2.4

173. Prospects

Cohesion and integration of medical security system3.1

First, all kinds of medical insurance can seamless connect, the insured persons can achieve barrier-free conversion between urban and rural areas, between different regions

Secondly, the establishment of administrative management system of unified management of urban and rural security system

Thirdly, we will establish a unified, efficient financing mechanisms and cost control mechanism

Finally, gradually reducing the gap between different populations basic treatment, improve the level of security

183. Prospects

Build a reasonable fund-raising system, improving the quality of medical services3.2

The core of Medical security is fund-raising and service supplyFinancing is to maintain the basic medical insurance level and an important factor of sustainable

Improving the quality of medical servicesUpward focus of information, service of passed down

193. ProspectsThe ratio of the cumulative balance with the spending

203. Prospects

Comprehensive reforms in medical field

Comprehensive reforms include: medical security system reform, medical and health system reform , the medicine circulation system reform

MI-HA: Medical institutions and health authorities

MI-DS: Medical institutions and drug suppliers

MI-Mi: Medical institutions and medical insurance

3.2

21

The interests of the relationship between three main is too complex and difficult to separate and supervise each other

HA

DS

Mi

MIPatient

Insured person

223. Prospects

A lot of investment for the construction of hardware facilities and the acquisition of expensive medical equipment；Input costs to patients, not only wasteful, also increased the burden of patients

233. Prospects

The interests of the separation MI from HA,DS,MI

3.2 Comprehensive reforms in medical field

HA

DS

MI

Mi

Patient

Insured person

243. Prospects

Health care reform itself is a process of constant development and improvement

Health care is essentially a huge financial problems, faced with fiscal sustainability challenges in the future

Thank you

Zhang Xiaojie(张晓杰 ) 18918211887

E-mail: sdxzxj@163.com