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China to improve employee basic medical insurance

Updated: Apr 22,2021 13:38    english.www.gov.cn

China will establish a general support mechanism for covering outpatient medical bills under the employee basic medical insurance, to ease people’s medical burdens, according to a circular issued on April 22 by the General Office of the State Council.

According to the document, general outpatient medical expenses of some chronic and special diseases, as well as frequently occurring diseases and common illnesses, incurring severe health damage and heavy costs, will be covered gradually by the unified accounts. The reimbursement ratio will start from 50 percent and will be tilted in favor of retirees as appropriate. Insurance benefits will be gradually raised as the capacity of the unified accounts increases.

The calculation method of individual accounts will be refined, the circular said. Employee contributions will remain under their individual accounts. Contributions from employers will all be channeled into the unified accounts. For retirees, a fixed amount will be allocated from the unified accounts to their individual accounts. The amount will be gradually adjusted to about 2 percent of the local average basic pension benefits in the year when the reform is enacted.

Also, the use of individual accounts will be widened. Family members may share in the individual accounts, to pay for medical treatment in designated medical institutions and purchase of medicines, medical devices and medical consumables from designated retail pharmacies. The use of individual accounts to pay for family members’ contributions to basic medical insurance for rural and urban non-working residents will be explored.

Supervision and management of the medical insurance funds will be strengthened, and audit and internal control mechanisms refined, to resolutely deal with irregularities such as fraudulent hospitalization claims and health insurance fraud.

The payment system will be improved to accommodate the general support mechanism for covering outpatient medical bills.

Provincial governments are required to announce implementation measures by the end of 2021 and achieve these goals within three years or so. The National Healthcare Security Administration and the Ministry of Finance should offer guidance, together with other relevant departments.

And the circular called on efforts to widely and creatively publicize the general support mechanism, and to establish a public-opinion monitoring mechanism to respond actively to social concerns.

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