CHINA URBAN SCHEMES
Latest Developments
Edition of 16/01/2008
1. MOH issued "Regulation of Community Health Administration (provisional)".
The provisional Regulation was made public today by the Ministry of Health. It requires that all community-based health institutes should establish a health file for each resident and household, provide continuous health education, health administration, home-visit services and after-treatment services, and place emphasis on specific groups such as the elderly, women, children, the disabled, low-income, those with chronic and catastrophic diseases.
For more information, see
http://news.xinhuanet.com/politics/2008-01/16/content_7430322.htm
Edition of 11/01/2008
1.Guangzhou: Universal cover of HI for all urban residents by end of 2008
According to the Labour and Social Security Bureau of Guangzhou, the HIUR will be launched this year to cover all urban residents who are not qualified for the HI scheme for urban working population.
This uninsured group is consisted of all school pupils / students, other types of children, working-age economically inactive persons and the elderly. It is estimated the total number of people in this group amounts to 1.5 million, equal to 45% of those insured under the existing urban HI scheme for working population.
With regard to benefit and financing, the maximum annual reimbursement payable to each insured person is universal, up to 72,648 RMB, equivalent to US$9884 at the current exchange rate. But the annual contribution and fiscal subsidy are various largely for those three sub-groups as descripted below:
| Children & Students | Working-age inactive | The elderly |
| 100 RMB | 600 RMB | 800 RMB |
| 20 RMB paid by the insured and 80 by the Gov. | 550 RMB paid by the insured and 50 by the Gov. | 300 RMB paid by the insured and 500 by the Gov. |
For more information, see
http://news.xinhuanet.com/newscenter/2008-01/11/content_7405638.htm
Edition of 09/01/2008
1. Beijing: Universal coverage for all urban economically inactive residents by end of 2008
The Municipal Government announced recently that its HIUR scheme was to be continuously extended to urban working-age economically inactive citizens after focusing on the elderly and children in the first phase in 2007. This remaining insured group accounts for 5 percent of its total urban population, about 400 thousand persons in total. It is envisaged that by the end of this year, all of urban residents will have access to basic health care secured by health insurance cover.
For more information, see
http://www.ben.com.cn/xwzx/jkws/rdxw/200801/t20080102_406107.htm
Edition of 18/12/2007
1. Shift of health protection policy
2007 saw a fundamental shift of the national health protection policy: from privatized market-led to publicized government-led with a view to achieving the goal of universal access to basic health care.
It is against this background that a number of actions has been taken, including:
- Formulation of the national health system reform proposal taking into account different even contradicted views expressed in nine independent reform proposals made by nine domestic or international organizations;
- Launch of the HIUR with high subsidies from the Government and a plan of extending the coverage to all targeting population by 2010;
- Continuous extension of the NRCMI and the HI for the urban working population.
For more information, see
http://news.xinhuanet.com/politics/2007-12/17content_7264119.htm
2. Development and promotion of urban community health care services
China is developing a new urban health care system with an emphasis placed on community. It is considered that the development of community-based health care services will contribute to the optimization of the distribution and use of the health care resources, to the convenience of the local residents, especially the elderly, the disabled, and women and children, and to the cost containment which benefits both the patients and the health insurance schemes.
By the end of 2007, various degreed community health care services were provided in 98% of prefecture-leveled cities and more than 50% of county-leveled cities.
For more information, see
http://news.xinhuanet.com/politics/2007-12/17content_7264119.htm
Edition of 26/07/2007
Some details of local HIUR proposals are provided as follows:
1. HIUR Proposal of Beijing Municipality
- Targeted people: 14.90 million at the initial stage, about 97% of the total urban economically inactive residents in Beijing (2005 data).
- Financing: There are two resources. Firstly, contributions from the insured persons with the flat rates set at 50 yuans and 300 yuans per insured per annum for the young and for the elderly respectively. These account for about 0.25% and 1.5% of the average annual disposable income per urban capita in 2006 (Ying Lijuan, 2007)). Secondly, subsidies from the Municipal and District Governments with flat rates set at 50 yuans and 1100 yuans per insured per annum for the young and for the elderly respectively. If the insured family is recipient of MLSG benefits or other similar programs, due contributions will be exempted. Therefore, the local governments in Beijing Municipality will provide more than half the financing resources that this scheme requires. It is estimated that a total of 400 million yuans per year will be flowed from the local governments to this new HIUR scheme to be operated in Beijing. This accounts for 0.44% of the total revenue of the Government of Beijing Municipality in 2005.
- Benefit package: Firstly, it concentrates on hospitalisation and outpatient care of severe diseases. Secondly, the reimbursement rate for the young group is set at 70% of insurable medical cost with a ceiling equal to 170,000 yuans per insured per annum, which is about 8.5 times the local average annual income in 2006, and the reimbursement arte for the elderly set at 60% reimbursable with a maximum of 70.000 yuans payable per annum.
For more information, see news.xinhuanet.com
2. HIUR schemes operated in Jiangsu Province
Jiangsu, the first province where all provincial-run cities have launched the HIUR scheme. ?Guidance on setting up the HIUR? was issued by the Provincial Government in March 2007. Some characteristics of the schemes operated in this province are described blow:
- The scheme has been implemented for one year in a number of the cities in Jiangsu Province, such as Huaiyin and Suzhou.
- Targeted people: 12 million. Of them, 1.53 million persons have been covered so far.
Suzhou: the coverage rate is about 80% now, only one year after the implementation.
Yancheng: due to a range of policies in favour of those from low-income families and highly disabled persons, persons from these groups have almost all participated in the HIUR scheme.
- Financing: The minimum financing rate is set at 150 yuans per insured and per annum by the Provincial Government. The city authorities are allowed to raise it if the local economic conditions are permitted.
Yancheng: the financing rate per insured per annum is set at 200 yuans, of which, 140 yuans by the insured and 60 yuans by the local governments. For those from low-income households, the ratio of contribution to subsidy is 60 yuans: 140 yuans.
Suzhou: the financing rate per insured per annum is 350 yuans, of which, 100 yuans from the insured and 250 yuans from the Government. But the contribution share of low-income households, high-level disabled persons, and orphans is exempted and replaced by a same amount of subsidy from the Government.
- Benefits: they focus on outpatient care of severe diseases and hospitalization mainly through risk and financing pooling for treating severe diseases.
Yancheng: the low-income group and the high-level disabled persons enjoy further policy advantages, i.e. certain out-patient costs are reduced by 30% and certain in-patient costs reduced by 50%, whilst one service cost is exempted. The maximum amount of reimbursable benefits is 30,000 yuans per insured per annum.
Suzhou: the maximum amount of reimbursable benefits is 100,000 yuans per insured per annum.
- Community-based medical services: They have two advantages: Firstly, the cost for treatment is relatively low. Secondly, the services are available at door sep, as they are located inside the residential communities where the insured live. Therefore, many local HIUR schemes encourage the insured to use these services by lowering threshold fee and raising reimbursement rate.
Huaian HIUR has advanced one step more: it uses it as a gatekeeper. There are a total of more than 70 contracted community medical centres in this city, each of the insured has to choose one of them as his or her family doctor. However, the insured can change his or her choice on an annual basis. Therefore, these community medical centres are improving their facilities and services to compete with each other for current 80,000 insured persons, which will be raised to 250,000 when the targeted people have all been covered.
For more information, see news.xinhuanet.comEdition of 25/07/2007
1. Launch of a new HI scheme aiming at covering up to 300 million people
A Conference on piloting a HI scheme for urban economically inactive residents (HIUR) was presided by Premier Wen from 23 to 24 July 2007 in Beijing. This is a follow-up activity to the decision of the Central Government on developing such a new HI scheme announced in March 2007.
After the launch of the NRCMI in 2003, this is the sole group left with no State-organized HI cover. It is estimated that this group has as much as up to 300 million people (Ma Kai, 2007), being composed of four sub-groups, namely children, the elderly, the disabled and other economically inactive working-age persons. Another characteristic of this group is its large proportion being those from poor and low-income households. The Government attempts to extend the HI coverage to this last vulnerable group by the HIUR system and aim to achieve a wide coverage by 2010.
When the State Council announced its decision on the development of the HIUR in March 2007, it laid out a number of principles as follows: a), It will be jointly financed by contributions from the insured and fiscal subsidies from the Government; b), The focus of the protection will, in principle, be placed on severe diseases-related medical care, both outpatient and inpatient cares include, and all other hospitalization cares; c), Unlike the existing urban HI for enterprises? employees, no component of individual savings accounts is to be included.
At the Conference, the Premier drew some detailed guidance lines for piloting the HIUR in selected regions: a), Each locally-designed and run scheme should determines a sound financing level and a sound benefit package, which is consistent with the financing capacity of the targeted people in different regions as well as the subsidizing capacity of the local governments. The financing of each local scheme may start from a relatively low level, which can be increased gradually at the late stage following the development of local economies. One of the primary objectives is universal coverage. b), The participation in this scheme is voluntary, but the local governments should encourage their people to join it through incentive policies. c), A range of regulations on financing and accounting need to be set up to secure an efficient management of the inflow and outflow of the fund. d), Government?s subsidies are to be reinforced. The subsidy from the Central Government will be transferred in full and in time, which is mainly allocated to the Central and Western Regions. The subsidy from the local governments should be fully and timely transferred too.
Premier Wen the development of the HIUR should be put into the ongoing reform of the whole health system and in particular, should made best use of the introduction of a community-based primary health care-provider mechanism.
According to Vice Premier Wu, Head of the Inter-Ministry Committee for the HIUR of the State Council, pilot proposals from 79 cities have been approved and are to be launched before the end of September 2007. The Committee will conduct an assessment of the piloting schemes and propose an extension plan in the early 2008.
For more information, see news.xinhuanet.com