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China to develop general support mechanism for covering outpatient medical bills under employee basic medical insurance and ease people’s medical burden

Wang Keju
Updated: Apr 07,2021 23:02 PM    english.www.gov.cn

China will establish a general support mechanism for covering outpatient medical bills under the employee basic medical insurance and broaden the use of funds in individual accounts, to ease people’s medical burden, the State Council's executive meeting chaired by Premier Li Keqiang decided on April 7.

In recent years, China has made outpatient treatment for chronic and special diseases, such as high blood pressure and diabetes, reimbursable under the medical insurance scheme, involving a large number of patients. Going forward, intensified efforts will be made to deepen the reform of medical and healthcare system, and strengthen the general support mechanism for covering outpatient medical bills under the employee basic medical insurance. More outpatient expenses will be included in medical insurance reimbursement to further reduce the burden on patients.

General outpatient medical expenses of some other chronic and special diseases, as well as frequently-occurring diseases and common illnesses, incurring severe health damage and heavy costs, will be covered by the unified accounts in a step-by-step manner.

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.

“This policy is crucial for people’s well-being. The medical reform in recent years has improved employee basic medical insurance and basic medical insurance for rural and urban non-working residents, and has essentially met people’s basic needs and achieved wide coverage. Such accomplishments have not come easily,” Premier Li said.

The calculation method of individual accounts will be refined. Employees’ 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.

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

“We will move forward step-by-step to establish and improve the general support mechanism for covering outpatient medical bills under employee basic medical insurance, and meanwhile, refine fund pooling for outpatient services under basic medical insurance for rural and urban non-working residents. Insurance benefits will be increased over time as the economy further grows, to lighten the burden that medical expenses put on the people,” Premier Li said.

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.

Governments at provincial levels may set a three-year transition period to gradually achieve the reform goals in an orderly manner.

“China has been a trailblazer in providing basic medical insurance as a public good. We have already gained some experience and must continue to explore the way ahead to steadily take the reform forward,” Premier Li said.

The meeting on April 7 also decided on policy steps to facilitate faster internet connection at lower prices to benefit businesses and the people. The construction and application of 5G services and gigabit fiber optic networks will be vigorously advanced. The upgrade and home-based installation of gigabit fiber-optic networks will be carried out, to develop the capacity for providing gigabit fixed-line and mobile internet services to urban households. By the end of this year, gigabit fiber-optic networks are expected to cover more than 200 million households.

Basic telecommunications service providers will be guided to cut the average broadband service rate and the average dedicated internet service rate for small and medium-sized enterprises by another 10 percent. Concessional internet service rates will be rolled out for special groups, including senior citizens and people with disabilities.

Any monopoly of broadband access or forced price markup in commercial buildings will be resolutely cracked down on, to ensure that users of telecom terminals will enjoy faster internet speed and affordable services.

“Flexible employment has expanded fast in recent years, which is very much underpinned by the essential telecommunications services and deeper fee cuts,” Premier Li said. “Faster internet speed and affordable services have also helped expand the market. Overall, the telecommunications industry has seen their profits grow.”

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