Department of Health Economics, School of Public Health, Fudan University.
Faculty of Humanities and Social Sciences, Dalian University of Technology.
Biosci Trends. 2018 Jul 17;12(3):215-219. doi: 10.5582/bst.2018.01054. Epub 2018 Jun 20.
The aims of this study were to describe health insurance reforms initiated by the Chinese government over the past two decades, to review their achievements in reducing the medical economic burden, and to summarize the challenges that still exist regarding a further reduction in out-of-pocket expenditures in this country. China has successfully attained the goal of providing health insurance coverage to almost the entire population by developing a mixed health insurance system, which consists of Urban Employees Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), New Rural Cooperative Medical Scheme (NCMS), and supplementary Catastrophic Health Insurance. Despite this achievement, China is still facing the challenges of a disparity in the medical economic burden by region and by health insurance scheme, relatively little protection from financial risk compared to developed countries, as well as low efficiency and quality of care under current payment systems. To further reduce the disparity in the medical economic burden and to increase the overall protection from financial risk in China, the Government should increase central government transfers to NCMS and URBMI enrollees in poor regions and increase the total amount of government subsidies to NCMS. In addition, China should improve the efficiency and quality of health insurance by further reforming the payment system.
本研究旨在描述中国政府在过去二十年中发起的医疗保险改革，回顾其在减轻医疗经济负担方面取得的成就，并总结在进一步降低该国自付支出方面仍然存在的挑战。中国通过发展混合医疗保险制度，成功实现了为几乎全体人口提供医疗保险覆盖的目标，该制度由城镇职工基本医疗保险（UEBMI）、城镇居民基本医疗保险（URBMI）、新型农村合作医疗制度（NCMS）和补充灾难性健康保险组成。尽管取得了这一成就，但中国仍面临着地区和医疗保险计划之间医疗经济负担差异、与发达国家相比财务风险保障相对较少以及现行支付制度下医疗服务效率和质量低下的挑战。为了进一步缩小医疗经济负担的差距，提高中国整体的财务风险保障，政府应增加对贫困地区新农合和城镇居民医保参保人员的中央政府转移支付，并增加新农合政府补贴总额。此外，中国应通过进一步改革支付制度来提高医疗保险的效率和质量。
