Exploration and Prospect of China medical security system reform
description
Transcript of Exploration and Prospect of China medical security system reform
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
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