Vice President Yu Hong accepts an interview with CFEN on “China’s accelerated medical insurance mutual aid guarantee mechanism reform”

On April 7, Premier Li Keqiang of the State Council convened an Executive Meeting of the State Council, at which the three core measures, i.e. establishment and improvement of basic medical insurance outpatient mutual aid guarantee mechanism for employees, broadened use of personal account funds and inclusion of more outpatient expenses in medical insurance reimbursement, were determined to further reduce the burden on patients.

Our Vice President Yu Hong stated in an interview with China Financial and Economic News on “acceleration of China’s reform of employee basic medical insurance outpatient mutual aid guarantee mechanism” that China’s employee medical insurance system is subject to a system model featured by the combination of overall funds and personal accounts. The medical expenses reimbursement ratio within the hospitalization policy of medical insurance can exceed 80%, while the outpatient expenses are mainly paid through personal accounts, for which the protection is relatively weak. Therefore, a large amount of funds are deposited in the personal accounts of middle-aged and young people as well as the insured persons with good health conditions but the amounts in the personal accounts of retirees and patients with chronic diseases are “insufficient”.

According to Yu Hong, the implementation of the two measures will significantly enhance the outpatient guarantee capacity of medical insurance. Based on her analysis, the inclusion of the expenses of some outpatient special chronic diseases and frequently occurring diseases with serious health damage and heavy cost burdens as well as the general outpatient expenses of common diseases in the scope of medical insurance overall payment will greatly reduce the burden of outpatient medical treatment on the common people; in addition, after the entry method for personal accounts of medical insurance is improved, y method, the personal payment will be included in the personal account, and the corporate payment will be fully allocated to the overall account, so that this part of personal account funds available will be used for outpatient mutual aid and the patients’ outpatient protection treatment can be significantly improved.

In Yu Hong’s opinion, broadening of personal account use scope is an effective “transfer payment” and an important breakthrough achieved in China’s medical insurance system at the system level. The use efficiency of medical insurance funds will be significantly improved accordingly. “Allowing family members to enjoy medical insurance mutual aid is equivalent to making a small-scale adjustment to the medical insurance funds within the family, so as to avoid the problem that young people with low medical payment needs have a great amount of idle personal account funds, while the elderly and patients with chronic diseases suffer from heavy medical payment burdens”, Yu Hong stated. As she mentioned, the employee medical insurance fund is a pool of funds formed through individual contributions and employer payments. The essence of its system design is the mutual assistance and mutual aid, and the achievement of mutual assistance lays a foundation for the family’s mutual aid of medical insurance throughout the society. “At current stage, we shall build a mechanism for family’s mutual aid at the institutional level and gradually expand the scope of mutual aid from the effective activation of small-scale mutual aid,” Yu Hong said.

In order to ensure the steady implementation of the aforesaid measures, it was proposed at the meeting that the provincial governments may set up a transition period of about 3 years to realize the reform goals gradually and orderly. As stated by Yu Hong, “at present, it is urgent to issue corresponding rules to further supplement and improve the reform measures. For example, the measure of exploring the use of personal accounts by the family members to participate in basic medical insurance for urban and rural residents and other personal payment measures still require steady implementation in various areas based on actual conditions.”