Integration of current identity-based district-varied health insurance schemes in China: implications and challenges

Abstract

With China's great efforts to improve public health insurance, clear progress has been achieved toward the ambitious full health insurance coverage strategy for all. The current health insurance schemes in China fall into three categories: urban employee basic health insurance scheme, urban resident scheme, and new rural cooperative medical system. Despite their phasic success, these substantially identity-based, district-varied health insurance schemes have separate operation mechanisms, various administrative institutions, and consequently poor connections. On the other hand, the establishment and implementation of various health insurance schemes provide the preconditioning of more sophisticated social health insurance schemes, the increase in the income of urban and rural people, and the great importance attached by the government. Moreover, the reform of the "Hukou" (household register) system provides economical, official, and institutional bases. Therefore, the establishment of an urban-rural integrated, citizen-based, and nationwide-universal health insurance scheme by the government is critically important to attain equality and national connection. Accordingly, the differences between urban and rural areas should be minimized. In addition, the current schemes, administrative institutions, and networks should be integrated and interconnected. Moreover, more expenditure on health insurance might be essential for the integration despite the settings of global financial crisis. Regardless of the possible challenges in implementation, the proposed new scheme is promising and may be applied in the near future for the benefit of the Chinese people and global health.

Role of the new rural cooperative medical system in alleviating catastrophic medical payments for hypertension, stroke and coronary heart disease in poor rural areas of China

“…This criterion doubled both for central and local governments and individual participants in 2008. In practice, NRCMS reimburses approximately 30% of inpatient expenditures [19, 20]. There are essentially four types of benefit and reimbursement models under NRCMS.…”

“…Inpatient deductibles were RMB100 (range 0–200)/$16.0 (range 0–32.0), RMB250 (range 0–500)/$40.0 (range 0–80.0), and RMB800 (range 0–2000)/$128.1 (range 0–320.0) at township, county, and provincial hospitals, respectively. The average reimbursement ceiling was RMB30,000 (range 8,000-180,000)/$4803.0 (range 1280.8-28818) for inpatient care [19]. …”

Integration of rural and urban healthcare insurance schemes in China: an empirical research

“…Establishing a proper transferring mechanism: With the market economic development and agricultural market reforms, many rural workers transit to cities for employment, most of whom receive little NRCMS reimbursement [9]. A transferring mechanism that links with the original system could well improve the situation.…”

“…To provide a better financial protection for the vulnerable Chinese seeking essential healthcare, China’s new medical reform was proposed to link up UEBMI, URBMI, NRCMS and urban and rural medical assistance programs. Besides, the integration would also cope with the rapid urbanization that more rural residents transit to cities for employment, as the current static and separate operation mechanisms with poor interconnections would fail to meet the dynamic healthcare needs of different population groups [9]. …”

Participants’ satisfaction on China's New Rural Cooperative Medical System:a cross-sectional Survey in Liaoning province of China.

“…Most members of NRCMS complained that the actual proportion of reimbursement was much lower than the publicized proportion of reimbursement when seeking hospitalization subsidies from the program [19]. First, most of the enrollees are located within the home county and expected to seek medical services in the designated hospitals.…”