Medical insurance system evolution in China☆
Introduction
Medical insurance is the major source of healthcare financing and payment in China. According to the latest Chinese Healthcare Reform Plan, the medical insurance system is one of the four components of the healthcare sector. One of the proposed reforms focuses on issues of public health, the medical service delivery system, and the pharmaceutical supply system (Healthcare Reform Plan, 2009). The medical insurance system makes the other three components of the healthcare sector interact with each other in the provision of healthcare.
Basic social medical insurance (BSMI) is the countrywide government system that serves as the primary third-party payer and the backbone for healthcare financing. Although BSMI does not yet provide universal coverage, the program has been expanding rapidly into both rural and urban areas in China over the past 5 years. The government has already proclaimed that universal coverage through BSMI will be achieved by 2011. In the meantime, commercial health insurance, which currently targets the upper class, is in its nascent stages.
This paper provides an introduction to the Chinese Social Medical Insurance System, especially BSMI. It discusses the program's history, elaborates on the reform initiatives, describes the reform dynamics and relevant policy environment, analyzes the problems existing in the system, and recommends some potential improvements to the system.
Section snippets
Evolution of basic social medical insurance system
BSMI consists of three schemes, including the basic social medical insurance scheme for urban employees initiated in 1998; the New Rural Cooperative Medical Insurance for Rural Residents program, which was officially established in 2003; and the basic social medical insurance for urban residents program covering mainly the elderly, students and children, which has been under a trial program in seventy-nine cities since 2007. The basic social medical insurance for urban residents program in
Main issues of the basic social medical insurance system in China
The basic social medical insurance system in China has made significant achievements in protecting against health risks and improving quality of health. However, the system includes certain adverse incentives arising from weaknesses in the design of the system. These adverse incentives should be examined together with the misconduct of various agents engaged in the healthcare services delivery system.
Concluding remarks
The government's recent interest in healthcare has produced a flourishing basic social medical insurance system. The coverage has aggressively expanded, especially since 2003, with the achievement of universal coverage imminent. However, the gap between the government's capacity to pay and the huge population and rising pressures from healthcare demands might become overwhelming. A multi-layer medical security system including government-driven basic care and market-oriented higher-level care
References (5)
- Chinese Social Security Communique (2001–2008). Issued by Ministry of Human Resource and Social...
Ministry of Health of the People's Republic of China, Chinese Health Statistics Yearbook 2008
(2008)
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The paper is funded by the “211 Research Project” in China.