Benefits of health insurance reform for outpatients


BEIJING — A number of Chinese cities have implemented a health insurance reform for urban employees and retirees, adjusting the monthly amounts deposited into their personal accounts and increasing reimbursement for outpatient medical expenses by at least 50 percent.

The National Healthcare Security Administration (NHSA) estimates that by the end of 2021, over 354 million employees and retirees will have joined China’s medical insurance system. According to experts, the change, which is likely to be implemented nationwide, will provide additional outpatient service assistance to individuals, particularly the elderly.

Equilibrium of Insurance Accounts

China’s health insurance system for urban employees and retirees consists of two components: mandatory personal accounts with contributions from both employees and their employers that primarily pay for ordinary outpatient services; and a pooled fund funded by employer contributions that reimburses hospitalisation bills, outpatient bills for serious diseases, and expenses for certain chronic diseases.

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Under the existing health insurance system, which has been in effect for almost 20 years, routine outpatient medical expenses can only be paid by personal accounts or by the citizens themselves. While some individuals with few clinic visits have tens of thousands of yuan in their personal accounts, others with regular hospital trips run out of personal account contributions.

According to Professor Jin Weigang of Zhejiang University, there is an “urgent need” for a mutual-aid structure to improve the ability of public medical insurance to reimburse outpatient expenditures and reduce the burden on patients.

After the implementation of health insurance reform, the funds put by employers into employees’ personal accounts will be transferred immediately to the pooled fund to assist with the reimbursement of routine outpatient medical expenses. The monthly deposit amounts for urban retirees will be based on regional per capita pensions rather than their individual pensions.

The reform will assist in meeting public medical demand on a larger scale.

Gu Xuefei, an expert on medical care policy at the China National Health Development Research Center, says that the change is meant to help outpatients without making employers and employees pay more.

weighted towards older people

According to NHSA data, China’s working population paid an average of 2,097 yuan ($306) for medical expenses in 2021, while retirees spent 8,002 yuan, or more than 3.8 times as much.

Wang Chaoqun, an associate professor at Central China Normal University, said, “Of course, the elderly are more likely to get sick and have higher medical costs.” He also said that elderly people don’t have enough money in their personal accounts to pay for outpatient care and medicines.

So that senior patients didn’t have to worry about money as much, the authority said that local governments should raise the rate of reimbursement for outpatient costs based on a 50 percent threshold.

In Hohhot, the autonomous territory of Inner Mongolia in northern China, policies favourable to senior citizens have been implemented. Retired employees are reimbursed at a higher rate for outpatient expenses than active personnel.

Under the new plan, the insured may use funds from their own account to assist their elderly parents and other family members.

Gu stated that by doing so, Chinese families will be better equipped to deal with medical concerns.

How people feel is important.

Gu said that the impact on all stakeholders, like the public and medical institutions, must be taken into account.

He urged all attendees to help ease the process of receiving medical treatment.

Official plans anticipate that the change will be completed within three years. The majority of regions have implemented their plans, although measures may vary from one region to the next due to disparities in economic strength and insurance cooperation.

Wang Zhen says that any reform takes time to take effect. He also says that other steps should be taken at the same time, such as being reasonable when adjusting the payout thresholds and maximum payment limits for the reimbursement of outpatient bills, adding more eligible pharmacies to the system where outpatient expenses can be reimbursed by the pooled fund, and including internet-based medical services in insurance coverage.

In certain places, optimization is currently underway. In Wuhan, Central China, for instance, an additional 4,065 pharmacies have been added to the system to help with attempts to cover outpatient charges through unified accounts. This is in addition to the more than 1,000 pharmacies that were included in a trial programme.

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