China Focus: Health insurance reform to benefit outpatient service users

• Published date: 20 February 2023
• Publication title: Xinhua Finance Agency

BEIJING, Feb. 20 (Xinhua) -- A number of Chinese cities have been implementing a reform of health insurance for urban employees and retirees, which adjusts the amounts deposited each month into their personal accounts, while raising the reimbursement percentage for outpatient medical bills to at least 50 percent.

ccording to the National Healthcare Security Administration (NHSA), over 354 million employees and retirees had joined China's medical insurance system by the end of 2021. Experts said the reform, which is expected to be rolled out nationwide, will provide further help to citizens -- especially older people -- in outpatient services.BALANCING INSURANCE ACCOUNTSChina's health insurance system for urban employees and retirees consists of two parts: mandatory personal accounts with contributions from both employees and their employers that mainly pay for ordinary outpatient services; and a pooled fund contributed by employers that is used to reimburse hospitalization bills, outpatient bills for serious diseases, and expenses for some chronic diseases.

This means that ordinary outpatient medical bills can only be paid by personal accounts or citizens themselves under the current health insurance system, which has been in place for over 20 years. While some people who rarely go to the doctor have tens of thousands of yuan in their personal accounts, some others find themselves running out of personal account deposits due to frequent hospital visits.

There is an "urgent need" for a mutual-aid mechanism to enhance the ability of public medical insurance to reimburse outpatient bills and ease the burden on patients, said Jin Weigang, a professor at Zhejiang University.After the health insurance reform, the money deposited by employers into employees' personal accounts will be directly paid to the pooled fund in order to support the reimbursement of ordinary outpatient medical bills.

For urban retirees, the monthly deposit amounts will be calculated based on regional per capita pensions instead of their own pensions."Health insurance is primarily public insurance, in which sense it provides mutual aid on the basis of joint contributions and shared responsibility," said Wang Zhen, a public economics scholar at the Chinese Academy of Social Sciences, adding that the reform will help meet public medical demand on a larger scale.

The reform is aimed at benefiting outpatients with no need for extra payments from employers and employees, said Gu Xuefei, a medical...