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Exploration and Prospect of China medical
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
Main content
1
Exploration of China's medical security system reform
2
Current problems
3
Prospects
3
1. Exploration
1.1
Reform process
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
4
1. Exploration
1.1
Reform process
The 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
Trial
By
access to basic public health services;
reform of public hospitals;
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
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1. Exploration
6
Universal health care system
Medical insurance for urban residents
New Rural Co-operative Medical System
Medical insurance for urban workers
Market
economy
Expansion of trials
Two pilots
Rural cooperative medical system
Labor medicare system
Free medicare system
The planned
economy
1. Exploration
Present
framework
Rural
population
7
Urban
population
Commercial health insurance
enterprise
Civil
serv
ants
New Rural Co-operative
Medical System
Basic
medical
insurance
for urban
workers
Supplement
Large
medicaid
Medical
insurance
for urban
residents
Medical assistance system
Man body
Foudation
1. Exploration
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1.2 Development of the medical security system
Expanding
Form
coverage
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
symbolic system
1. Exploration
1.2
9
Development of the medical security system
2006
NCMS
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
52.1
58.9
96.3
113.4
156.6
246.2
308.5
155.8
346.6
662.3
922.9
1187.8
1710.2
2408.0
2.72
4.53
5.85
7.59
10.87
13.15
17.45
(%)
Per capita
financing(RMB)
fund
expenditure(billi
on RMB)
Benefit people
(billion)
1. Exploration
1.2
10
Development of the medical security system
30000.0
MIU-W
25227.1
25000.0
26485.6
23734.7
21937.4
19995.6
20000.0
18020.0
15731.8
15000.0
13782.9
12403.6
10901.7
9401.2
10000.0
7285.9
5000.0
3786.9
0.0
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
2. Current problems
2.1 Fragmentation and differentiation of medical security system
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.
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2. Current problems
2.2 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
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13
The proportion of medical expenses
100%
90%
20.4%
80%
Personal expenses
70%
45.2%
60%
50%
47.4%
Social health expenditure
40%
34.5%
30%
20%
10%
32.2%
Government health expenditure
20.3%
19
78
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
0%
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
Type
MIU-W
Number
(billion)
Rate (%)
Per capita
health
expenditure
(RMB)
Per capita
insurance
(income) (RMB)
The
proportion of
insurance
cost %
2.1
16%
1,337
970
72%
（1,293）
MIU-R
1
8%
1,337
170
13%
(200)
NCMS
8.1
61%
565
85
15%
(100)
No insurance
2.1
16%
920
13.3
100%
920
(including free
medical care)
Total
0
0
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2. Current problems
2.3 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.
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2. Current problems
2.4 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?
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3. Prospects
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3.1 Cohesion and integration of medical security system
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
3. Prospects
3.2
Build a reasonable fund-raising system, improving
the quality of medical services
The
core of Medical security is fund-raising and service
supply
Financing
is to maintain the basic medical insurance level and an
important factor of sustainable
Improving
Upward
the quality of medical services
focus of information, service of passed down
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3. Prospects
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The ratio of the
cumulative balance with
the spending
3. Prospects
3.2
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
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21
HA
The interests of the
relationship between
three main is too
complex and difficult
to separate and
supervise each other
DS
MI
Mi
Patient
Insured person
3. 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
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3. Prospects
23
3.2 Comprehensive reforms in medical field
The interests of the
separation MI from
HA,DS,MI
HA
MI
Patient
DS
Mi
Insured person
3. 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
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Thank you
Zhang Xiaojie(张晓杰)
18918211887
E-mail: [email protected]