China News Service, March 25 (Xinhua) According to the website of the National Medical Insurance Administration, most areas across the country have recently completed the centralized collection and payment of medical insurance fees for urban and rural residents, and insured people have enjoyed medical security services. What is the status of national basic medical insurance coverage? Are resident medical insurance payment standards reasonable? Are residents who are not sick "suffering a disadvantage" by participating in basic medical insurance? The person in charge of the relevant department of the National Medical Insurance Administration was interviewed by reporters on issues of social concern.
Question: Some people say that the number of urban and rural residents participating in medical insurance in my country has continued to decline in recent years. Others claim that there is a “wave of withdrawals” of medical insurance in rural areas in some areas. Is the relevant statement true?
Answer: This statement is inaccurate. The coverage of my country's basic medical insurance has stabilized at more than 95%, and the quality of insurance continues to improve.
From a macro perspective, the number of residents insured by medical insurance remains stable. Relevant data have fluctuated slightly in recent years, mainly due to two reasons. The first is insured data management. Starting in 2022, the medical insurance department took the launch of the national unified medical insurance information platform as an opportunity to clean up a total of 56 million residents' inter-provincial and intra-provincial duplicate insurance data for two consecutive years. This is the main reason for fluctuations in resident medical insurance participation data. The second is to optimize the insurance participation structure. Due to new employment factors such as the employment of college students after graduation, some people who originally participated in resident medical insurance have switched to employee medical insurance. From 2020 to 2023, 5 to 8 million insured persons will switch from participating in resident medical insurance to employee medical insurance every year, resulting in The number of residents covered by medical insurance and the number of employees covered by medical insurance have waxed and waned.
From a micro perspective, the National Medical Insurance Administration recently sent personnel to conduct on-site surveys on insurance participation in 8 villages in 8 provinces including Inner Mongolia, Heilongjiang, Henan, Hubei, Hunan, Sichuan, and Gansu, which have relatively weak work foundations. The survey shows that among these eight villages, the number of people participating in resident medical insurance in 5 villages will increase in 2023 compared with 2022, the number of insured people in 3 villages will decrease slightly, and the overall number of insured people in 8 villages will increase by 151 people compared with 2022. Taking a village in Macheng City, Hubei Province, where "many people have withdrawn from insurance" was reported online as an example, field research found that 97.4% of the residents in the village were covered by medical insurance in 2023, and 30 people were actually insured, and those who were not insured due to special reasons Just an example. Many villagers said that fortunately, having medical insurance has effectively solved their worries about medical treatment.
However, we must also note that with the continued development of my country's population aging and low birthrate, especially with the decline of my country's total population, the number of residents insured by medical insurance may also decrease steadily or slightly in the future, and even the total number of insured persons may also decrease. May be reduced.
Question: In 2023, the individual payment standard for medical insurance for urban and rural residents in my country will be 380 yuan. Some people think that the fee standards are too high and the rate of increase is too fast. What to make of this view?
Answer: Some public opinion believes that compared with the payment standard of 10 yuan/person when the "New Rural Cooperative Medical System" was established in 2003, the current payment standard for resident medical insurance premiums of 380 yuan/person has increased too fast. However, we should not simply look at the increase in payment standards, but what this increase of 370 yuan has brought to the general public. In fact, behind the rise in medical insurance financing standards is a greater improvement in the level of medical insurance services.
First, the scope of protection for the masses has been significantly expanded. In the early days of the establishment of the "New Rural Cooperative Medical System" in 2003, there were only more than 300 types of reimbursable drugs. Drugs for the treatment of cancer and rare diseases were almost not reimbursable, and treatment options for patients with serious illnesses were very limited. At present, my country's medical insurance drug catalog contains 3,088 kinds of drugs, covering more than 90% of the drugs used by public medical institutions, including 74 kinds of tumor-targeted drugs and more than 80 kinds of drugs for rare diseases. In particular, many new and good drugs can be included in the medical insurance catalog in accordance with regulations soon after they are launched in China. Take the drug "Imatinib" for the treatment of leukemia as an example. When the drug was first launched in China, the annual out-of-pocket cost for taking the drug was nearly 300,000 yuan. Many patients and families had to "sigh in anticipation of the drug" and face the heavy financial burden. and a fragile life; since the establishment of the National Medical Insurance Bureau in 2018, after the drug was centralized and reimbursed by medical insurance, the patient's annual out-of-pocket cost for taking the drug has been reduced to about 6,000 yuan. The continuously improving medical insurance system has made countless patients and families Rekindle hope in life.
Second, various modern medical examination, diagnosis and treatment technologies are more accessible. Over the past 20 years, with the strong support of medical insurance policies, medical service capabilities have achieved leapfrog development. The diagnosis and treatment capabilities of major diseases are comparable to the international advanced level, and some fields are leading the world. The medical examinations, diagnosis and treatment methods that patients enjoy are making great strides in the direction of digitization, intelligence, and precision. High-tech equipment such as color ultrasound, CT, and MRI are rapidly becoming popular. Painless surgery, minimally invasive surgery, and other diagnosis and treatment methods that were previously high and out of reach Technology has become increasingly popular and has been included in the scope of medical insurance reimbursement, and the majority of insured patients have enjoyed better medical services.
Third, the proportion of people’s medical reimbursement has increased significantly. In 2003, when the "New Rural Cooperative Medical System" system was first established, the reimbursement ratio for hospitalization expenses within the scope of the policy was generally around 30%-40%. The proportion of people paying out of pocket was relatively high, and the medical burden was heavy. At present, the reimbursement ratio for hospitalization expenses within the policy scope of my country's resident medical insurance remains at around 70%, which significantly reduces the medical burden of the people, which will inevitably lead to an increase in medical insurance financing standards. At the same time, as my country's population ages, the public's medical needs increase, and medical consumption levels increase, it is also necessary to strengthen the raising of medical insurance funds to provide stable and sustainable protection for the people.
Fourth, the level of service capabilities to the masses has been improved by leaps and bounds. In 2003, people participating in the "New Rural Cooperative Medical System" could only be reimbursed conveniently for medical treatment in the county (district) hospital. The reimbursement rate for medical treatment in other places was much lower, and they could not be settled directly. At present, people insured by the resident medical insurance can not only enjoy medical reimbursement in their own county (district), city (state), and province, but also enjoy direct settlement services for inter-provincial hospitalization expenses in nearly 100,000 designated medical institutions across the country, providing the majority of It provides a solid guarantee for people who live, travel, and work in other places to seek medical treatment. In addition, the outpatient medication guarantee mechanism for hypertension and diabetes has been established from scratch, so that people no longer have to worry about buying medicines, and has helped about 180 million urban and rural residents with "two diseases" reduce their medication burden by 79.9 billion yuan; the "triple guarantee system" will only be available in 2023 It has benefited more than 180 million medical treatments for low-income rural residents every year and helped reduce the medical cost burden by more than 180 billion yuan.
In the past 20 years, although the per capita financing standard for resident medical insurance has increased by 370 yuan, the benefits brought to the people by the improvement of medical security levels and services are far beyond the measurable amount of 370 yuan. In fact, in order to support the substantial improvement in the ability and level of medical insurance services, the state has adjusted the annual insurance payment standards for individual residents and at the same time, the fiscal subsidies for residents' participation in insurance have been increased significantly. From 2003 to 2023, the national financial subsidy for residents to participate in insurance increased from no less than 10 yuan to no less than 640 yuan. If a resident continuously participates in insurance from 2003 to 2023, the total medical insurance premium will be at least 8,660 yuan; of which the total financial subsidy will be at least 6,020 yuan, accounting for about 70% of the total premium; the resident’s personal payment will total 2,640 yuan, accounting for only the premium about 30% of the total.
With the strong support of the continuously improving medical insurance system, the demand for medical treatment among residents across the country has been rapidly released, and the health level has been significantly improved. According to statistics, from 2003 to 2022, the total number of diagnoses and treatments in my country's medical and health institutions increased from 2.096 billion to 8.42 billion; the average life expectancy of national residents increased from 72.95 years in 2005 to 77.93 years in 2020. At the same time, personal health expenditures accounted for 27.0% of total health expenditures in the country, from 55.8% in 2003 to 27.0% in 2022. Nearly 1.4 billion medical insurance participants enjoy higher-level medical conditions, wider medical coverage, higher proportions of medical insurance reimbursement, and more convenient medical insurance services. This is because China’s medical insurance system protects people’s lives and health.
Question: Do the medical insurance reimbursements enjoyed by urban and rural residents come from individual residents’ contributions?
Answer: The premiums for urban and rural residents' medical insurance are fixed and paid annually. The financing standard in 2023 is 1,020 yuan/person, of which financial subsidies are not less than 640 yuan/person, which is the bulk of the financing; the individual payment standard is 380 yuan, which is only for financing. The government will also provide full or partial subsidies to needy people such as those living on minimum living allowances.
The medical premiums paid by residents, together with financial subsidies, form a common basic medical insurance fund pool for the vast number of urban and rural residents in my country, which has brought continuous improvement to the basic medical insurance protection level of the general public. Here, I would like to add some additional data for 2023: First, the total personal medical insurance payment for urban and rural residents nationwide is 349.7 billion yuan; second, the fiscal year-round subsidy for residents’ payment is 697.759 billion yuan; third, the annual expenditure of the resident medical insurance fund 1,042.3 billion yuan. The total annual expenditure of the residents' medical insurance fund is 2.98 times the total amount of individual residents' contributions.
Question: What do you think of comments such as "I didn't get sick after paying for medical insurance, so I suffered a loss"?
Answer: The occurrence of diseases is often uncertain. In modern society, faced with the sudden onset of major diseases, it is difficult for individuals and families to bear the high cost of treatment alone. The essence of insurance is to pool the efforts of all parties to help individuals and families who are unfortunate enough to be seriously ill to withstand the risk of large medical expenses. Therefore, participating in medical insurance means "being protected when you are sick and benefiting others when you are not sick." It should be a rational choice for everyone when facing the uncertainty of disease risks.
In 2022, the total number of outpatient consultations in medical and health institutions across the country will be 8.42 billion, and each person will visit medical and health institutions 6 times a year on average. There were 247 million admissions to medical and health institutions across the country, and the annual hospitalization rate was 17.5%; that is to say, on average, 1 in 6 people was hospitalized once a year. The probability of residents getting sick or getting seriously ill is not as low as imagined. During the previous poverty alleviation campaign, 40% of those who fell into poverty were caused by illness or returned to poverty due to illness, which also shows that illness has a great impact on family economic conditions.
Data show that in 2022, the average hospitalization expense for residents of my country's resident medical insurance will be 8,129 yuan. Calculated based on a reimbursement ratio of 70%, the average medical insurance reimbursement for one hospital stay is 5,690 yuan; if residents pay the individual contributions for continuous insurance from 2003 to 2023 The premium is saved, and compound interest is calculated at an annual interest rate of 5%. By 2023, the principal and interest will total 3,343.1 yuan. In other words, the amount of medical insurance reimbursement for residents after one hospital stay far exceeds the income from saving total personal premiums for 20 consecutive years.
Therefore, it is wrong to say that "you will suffer a loss if you don't get sick after paying for medical insurance", and it is not cost-effective in terms of accounting.
Question: Some netizens said, “Young people who are in good health don’t need to be insured, and only the elderly and children can be insured.” What do you think of this point of view?
Answer: This view is somewhat representative among some people. But if you consider all factors comprehensively, you will find that this is actually "settling a small score and suffering a big loss."
First, the disease spectrum in our country is changing. With the development of modern science and technology, more and more diseases have been detected and diagnosed early. Especially with the acceleration of the pace of modern life, the increase in work pressure and living habits and other reasons, hypertension, diabetes, heart disease, etc. , malignant tumors and other diseases are becoming younger, and the health risks faced by young adults cannot be underestimated.
Second, young adults are more vulnerable to disease risks. The young and middle-aged people are the "backbone" of the family. Once they suffer from a serious disease, without medical insurance, it not only means that the family will bear huge treatment costs, but also means that the family will lose important financial resources. This double blow will not only have a disastrous impact on the family financially, but will also further affect the education and growth of their children. Therefore, the "backbone" of the family needs more focused protection from medical insurance.
To sum up, young adults should be insured. This is not just for yourself, but also to provide protection for parents, children and families.
In the next step, the National Medical Insurance Administration will continue to leverage the certainty of my country's basic medical insurance system to deal with the uncertainty of disease risks, do its best and within its capabilities, strive to ease the cost burden of medical treatment, and provide better quality medical insurance to the general public. Serve.