Abdula Hamed
The problems of China's Health care system
ISBN: 978-3-8366-4336-8
Herstellung: Diplomica® Verlag GmbH, Hamburg, 2010
Zugl. Fachhochschule Furtwangen, Furtwangen, Deutschland, Bachelorarbeit, 2009
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Abdula Hamed
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Kurzfassung
Thema der Bachelor-Thesis:
Die Problematiken des Gesundheitssystem Chinas
Verfasser:
Abdula
Hamed
1. Betreuer:
Herr Prof. Dr. med. Dipl.-Ing. (BA) Gerd Haimerl
2. Betreuer:
Herr Prof. Dr.-Ing. Johannes Ebberink
Semester:
Wintersemester
2009/2010
Hinsichtlich vieler dramatischer Szenen im Gesundheitssektor Chinas und nach
intensiver Recherche über die Problematiken des chinesischen Gesundheitssystems
wuchs das Interesse, mehr über die Problematiken der Gesundheitsversorgung in
China zu erfahren, um hierfür Lösungsansätze zu erörtern. Nach der Einführung der
Reform- und Öffnungspolitik von Deng Xiaoping wird auf der ganzen Welt von
Chinas atemberaubendem Aufstieg berichtet. Der Wandel zum liberalisierten Handel
führte zu einem verminderten Armutslevel und festigt China an die spitze der
weltweiten Wirtschaftsmacht. Es ist nicht zu leugnen, dass sich China in einer Ära,
von noch nie da gewesener Empfänglichkeit hinsichtlich ausländischer Einflüsse,
befindet. Neben den Vorteilen die die neue Reform mit sich gebracht hat, sind
innerhalb des ehemaligen zentralisierten Krankensystems schwere Probleme
aufgetreten. Trotz dem intensiven Engagement der Regierung gibt es zahlreiche
Bevölkerungsgruppen die im Gesundheitssystem benachteiligt werden. Nicht nur die
Einführung der Wirtschaftsreform ist für die Chinesen ein Segen, sondern auch die
Verbesserung der Gesundheitsreform hat viel zum höheren Lebensstandard
beigetragen. Anderseits hat der Reformwechsel im Gesundheitssystem Nachteile mit
sich gebracht. Durch die höhere Qualität der medizinischen Versorgung, ist auch der
Zugang aufgrund Preiszuschläge schwerer als je zuvor. In dieser Thesis wird das
Fehlverhalten vieler Bauern hinsichtlich der Gesundheit und Krankheit dargestellt, als
auch die Funktion des zu überteuerten Gesundheitssystems, das im Schatten des
Einheitsstaates von der Regierung geführt wird. Des Weiteren werden Lösungs- und
Verbesserungsvorschläge vorgestellt, die zu einer Verbesserung des
Gesundheitssystems in China führen können.
Abdula Hamed
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Abstract
Title of Bachelor-Thesis:
The problems of China's health care system
Author: Abdula
Hamed
1. Examiner: Herr Prof. Dr. med. Dipl.-Ing. (BA) Gerd Haimerl
2. Examiner:
Herr Prof. Dr.-Ing. Johannes Ebberink
Semester:
Wintersemester
2009/2010
A couple of dramatic scenes were seen in China and also after getting more
information about the problems of the healthcare system of China the decision were
created to learn more about the healthcare system of China for being able to
present solutions for the general problems. Trough the change in 1978 from
communism to the implementation of the economic reforms by Deng Xiaoping the
media all around the world is talking about the incredible increasing of China. The
changes to liberalized trade principle waged to decreased poverty levels and
determine China on the path to economic sharpness. There is no doubt that China
ushered in an era of unprecedented receptivity to foreign leverage. But beside the
positive effects of the reform it also showed massive change within the once
centralized medical system. Even though many efforts of the government some
sections of the population are at a disadvantage. The implementation of the
economic reforms have been a blessing for the Chinese as well as the improved
reforms concerning to the healthcare system. On the other hand through the higher
quality of the healthcare system the access is very difficult due rising costs.
In that research it will be schematize the misbehaviour of many farmers concerning
to health and disease and it will be shown that the present health care system that is
working in the shadow of the centralized state which is managed by the government,
is not the efficient way concerning to the rising costs. Furthermore solution and
suggestions for improvement which could lead to an improvement in the health care
system in China are introduced.
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Table of content
Kurzfassung... 2
Abstract ... 3
Table of content... 5
List of abbreviations ... 7
Foreword ... 8
1 Introduction... 9
2 China's healthcare organisation... 12
2.1 The development phase of the healthcare system ... 12
2.2 China's healthcare system ... 13
2.3 The health care financing system of China... 16
2.4 The healthcare insurance of China ... 18
2.4.1 Basic medical insurance for urban workers... 18
2.4.2 Basic medical insurance for urban residents... 20
2.4.3 The rural cooperative medical care system... 23
2.4.4 The survey of University students' free medical care system ... 27
2.4.5 Survey of children's medical insurance ... 28
2.4.6 Survey of medical services for foreigners... 30
2.5 Refund of costs through the healthcare insurance ... 33
2.5.1 The doctor choice and hospital choice behaviour in China's New Cooperative Medical
System ... 33
2.5.2 Main medical expenses reimbursement problems of the New Rural Cooperative Medical
System ... 35
2.5.3 Subsidies for severe disabilities... 41
2.6 Reasons for non- participation of farmers in the medical care system... 43
3 Reasons for the increasing poverty in the country-side... 45
3.1 Back into poverty due to illness ... 45
3.2 The generally low cultural quality of the rural labour force ... 46
3.3 The rural economic and social environment ... 46
3.4 The relatively poor natural conditions in rural areas ... 48
4 Problems in the supply of drugs ... 49
4.1 Prevention of the circumvention of law ... 50
4.2 Some Regulations of the Drug Control Law... 52
5 Relation between the doctor and patient ... 53
5.1 Medical corruption... 55
6 Problems during the treatment ... 58
6.1 Bail as a delay of the treatment ... 58
6.2 Lack of Medical Knowledge of the farmers towards the pains... 63
6.3 Problems with the diagnosis of illnesses ... 70
6.4 Hygiene problems ... 74
7 Health and illness ... 81
7.1 Understanding under "health and illness" of the World Health Organization... 81
7.2 Understanding under "health and illness" of the farmers... 83
7.3 Misbehaviour of farmers concerning health and illness... 85
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8 "Market failure" in the health services in the absence of the government intervention ... 86
8.1 Alternative models of government intervention... 89
9 Suggestions for the problem of Chinas health care system ... 91
10 Conclusion ... 93
11 References ... 95
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List of abbreviations
Abkürzung Begriff
NRCMS New Rural Cooperative Medical System
WHO World Health Organisation
e.g. For Example
MRI Magnetic Resonance Imaging
CT Computer Tomography
SARS Severe Acute Respiratory Syndrome
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Foreword
At this point I would like to thank the people who have stood to me during the
treatment of my Bachelor thesis aside:
My heartiest thank-you is valid Mr. Prof. Dr. Med. qualified engineer (BA) Gerd
Haimerl who has supported to me with his engagement and his perpetual help and
has supported me over and over again on with worth-woollen to advice. I thank him
for his patience, and the extraordinary coordination in spite of the distance between
Germany and China. I show his zeal and hard work really very much to estimate.
I thank also rather warmly the staff of the University of Soochow in China which have
stood to me any time aside and have supplied me with enough material and
information. My thanks are also directed to Mr. Prof. Dr. Zhu as well as the dean of
the faculty of mechanical engineering Mr. Prof. Dr. Zailiang Chen. They gave me the
chance to write my dissertation on the Soochow University as well as Mr. Prof. Dr.
Yannian as my supervisor has assigned whose auxiliary readiness I estimate very
much. I would also like to thank Mrs. Suzhen Wu from the foreign affairs office who
has formed the stay to me very pleasantly.
By this work I have learnt not only the methodology of a scientific work in China in
cooperation with Germany, but also things which completely took place off this topic -
in particular human warmth which auxiliary readiness of my surroundings have
deeply impressed me, so that I am really stirred to tears, thank you very much!
Soochow, 31.12.2009
Abdula
Hamed
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1 Introduction
Reasons and motive of the work
In the public media the positive developments of China dominate there to the
industrial state, while the shadow sides of this development, among the rest, the
health system are hardly picked out as a central theme.
A row of dramatic scenes and riots in the town and her surroundings, caused by
varied deficits in the health system, was decisive to write about this complicated
subject and their problems. To learn more about the reasons of the deficits in the
health system was the aim. In spite of many efforts of the government some
population groups seem to have been neglected by this system up to now. Many vital
menaces caused by illnesses ask for an urgent solution. This work wants to pick out
as a central theme the failure of the farmers in the area "Health" and "Illness",
discuss the being in way difficulties and indicate possible improvements in the health
service, the area "doctor's patient" as well as structural areas concerning.
Then as a result of the investigation it should also become possible for population
groups as for example for farmers and for financially weaker groups of town-dwellers
to be able to call away adequate achievements from the health department.
On the one hand with personal experiences, observations and views on the other
hand, the contact with Chinese by birth and beginning doctors could be always called
away the topical references that supply a picture of the current state in China. These
experiences and observations should underpin my criticism of the ruling health care
system.
Indicating of various deficits in the health service should serve for a future
improvement of the same.
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Objective and subject areas
a) The organisation of the health service
Illnesses and disasters accompany the humanity since primeval times. Nevertheless,
the kind, recognition and treatment of illnesses have changed by the social
developments recently rapidly. For the judgement of the topical situation of the health
system the work offers a structural and institutional comparison between the town
and their surroundings. The present draughts and facts are observed under various
aspects and are analysed then.
In this work concrete points are worked on for the first time to bring the grounding of
the health system to the reader. On this occasion, it will be explained for the first time
which organisations in the health system exist in that of the town as well as in the
country. Afterwards general basic principles of the health service as well as the
health insurance sector are described.
b) Doctor's-patient's-respect
In modern China becomes traditional above all on Confucius being based, ethics
more and more by profit striving substituted. Today in the past as a holy called
medicine staff ,,white lion (bailang) "is often called.
Here the setting should be examined by patients and doctors concerning the medical
care and phenomena and selective experiences are shown concerning uses of drugs,
emergency treatment as well as the phenomenon of the Hongbao.
C) Health and illness
The reason why many people do not feel their illness as a personal destiny is
because the numerous tragedies which would be to be prevented by better education
and information easily occur. The traditional rituals play an important role which can
be in way by the production of a clinical picture as well as the prevention measures
and with the health care. These ideological images concerning illness and health
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which are delivered by the traditional are described and will be shown through some
case studies.
Method
This work refers to the general big towns of China like Suzhou as well as the
neighbour towns like Shanghai or also Beijing. Furthermore there are various villages
which have been suggested by informants.
Over and over again big discrepancies appear between official and anonymous
statements to the health system. These differences complicate an exact analysis of
the situation.
Concerning the literature it was very difficult to find topical and true information about
the current situation of China's health care system. Hence, the numerous Chinese
references which have been recommended by doctors and medicine students were
selected beside western references.
Finally, briefly usable strategies are discussed for the solution of the problems
appeared on the basis of hypotheses and proposals namely mainly in such a way
that for an other discussion of the future measures can be led to allow with it the
affected population groups an improvement of the situation.
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2 China's healthcare organisation
Through the last years China's healthcare system was developed through several
concepts which were created by the government. In the following chapter the
proceeding of the healthcare system will be described as well as how the different
structures are working in the urban area and in the countryside.
2.1 The development phase of the healthcare system
The development of the entire health care system is divided into three phases. The
first phase includes the years from 1995 until 1999. There was the lowest safety in
the health insurance for the inhabitants in the town. The inhabitants in the
countryside did not even have any kind of health insurance. The second phase was
from 2000 until 2004. In that time they increased the aid fund for disadvantaged
groups like the unemployed population. According to the opinion other farmers the
unemployed population that got the aid fund would have a higher standard of living
then the poor farmers. But in that phase these poor farmers were ignored by the
program of healthcare. After developing the healthcare system till 2005 the poor
farmers were integrated into the third phase of the program in the healthcare system.
The law will determine that the insurance money should be at least 10 Yuan. For all
whom that have children or a lower standard of living, the communal tax office will
pay the above mentioned amount. The status of the healthcare insurance in China
around the countryside is pre much the same. In 2003 the Chinese State Council
decided to prepare some strategies for the current insurance in terms of the
countryside. They were focused on the health care which were introduced in the
fifties for the employee of the government and nationalised companies.
The aim was to upgrade different fields like accident welfare, maternity protection,
disease welfare, pension insurance and social welfare benefits.
1
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2.2 China's healthcare system
Chinas healthcare system is divided into two different parts for two different areas.
Since decades most of the money which came from the government went to the town
inhabitants while the rural poor got 63 times less. The town inhabitants were working
for companies which were government properties. During the years the inhabitants
were not afraid or even worried about getting unemployed or shortage of money.
Because of staff reduction in the past through insolvent adventure many people could
not pay for health insurance anymore. So the government decided to establish a
healthcare system in which all the people are divided in different groups like
unemployed persons, children, disabled people, students and pupils. These groups
get financial help for treating diseases, births and emergencies. It is undeniable that
town people have an advantage compared with country people. The government
spent in 1978 for about 170 million town inhabitants 5.1 billion Yuan for healthcare
when 790 million country people got entirely 230 million Yuan. In comparison of both
inhabitants there is a relation of 1:22 to the disadvantage of the country people in
1980. In 1984 until today the relation of them has been 1:63 to the disadvantaged of
the country people.
Since many years the country people were in disadvantage concerning to the
healthcare compared with the town people because of none existing of pension
insurance and national aids. But in the meantime fewer and fewer people are able to
afford the increasing treating costs in the hospitals. For the sick country inhabitants
there is no way to pay these expensive fees except taking expensive and illegal
credits from private persons. By this time the reason for the latest generation of
poverty is seen by the illegal way for getting money. Most of them are not able to pay
the mostly huge amount back. In the majority of cases it comes to vicious circle.
Without help it is not possible to get out of that vicious circle.
There is a project in the villages called "five guarantees" for the persons in need of
care. This initiative is especially for sick people, orphan children, childless marriages
and widowed people from the village. All these people get financial help for being
able to defray the basic requirements like nourishments, clothes, fuel as well as an
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education for the children. As time passed after the households have been
strengthened they refused to continue paying the healthcare. Therefore the project
"five guarantees" has been stopped and many sanitary stages were closed. The
trained doctors from the university also refused treating in the countryside because of
their financial poorness. They prefer to work in the cities where they have the
possibility to earn more money. Because of that problem the government allowed the
traditional healers known as "bare-foot doctors" and shaman that had been followed
in the past by the government to continue treating people for improving healthcare in
the countryside. Recently, the government established a new rural farmer's insurance
policy. The village doctors in the country region "bare-foot doctors" do not have only
the old-age insurance, but also financial subsidies from the government.
According to Implementation of the village doctors' pension plan provisions, village
doctors' who enjoy the new farmer's insurance are divided into two grades. Firstly,
village doctors' who reach legal and emeritus age, and own more than 20 years
working experience in the village, shall enjoy the new rural social pension insurance.
The participant's insurance premium, the government subsidy pays 60 %, a total of
12,863 Yuan go entirely to the personal accounts, community health service stations
and village doctors' individuals share 40 %. Secondly, the village doctor who have
more than 30 years medicine experience but not working as a village doctor anymore
(over 50 years old and own the license of village doctors at least 15 years), and did
not enjoy other social basic old-age insurance, can participate in the new farmer's
insurance. Village doctors', who reach legal and emeritus age, only have to pay 8575
Yuan at one time in cooperation with the community health service station. Then the
person in line with the conditions of the first category will get 200 Yuan / month, the
person in line with the conditions of the second category will get 140 Yuan / month.
Village doctors formerly known as bare-foot doctors, they Medicare door-to-door in
the village and protect a large number of the peasants' health. The implementation of
the village doctors' pension plan to some extent solve village doctors' pension
problem, give bare-foot doctors a pair of warm shoes and to make them walk
more convenient and comfortable.
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In 2004 the Chinese secretary of health and human services said that the Chinese
government would be ready to establish an emergency plan in some parts of the
country. Because of the bad health environment the government agreed an
investment about 11.4 Billion Yuan. The major investment points were the
improvement of the treatment system, prevention and checking systems of diseases.
The government has also changed its policies concerning medical device imports.
In 2000 the tariffs on medical equipment import fell from 9.9 % to 4.7 %. The medical
device market increases within two years of almost 60 % within 20032005 in
comparison to 70 % in 19972003.
2
After the modernization of the hospital the prices for the health care services rose up
although the numbers of hospital have been increased during the last years. In 1980
to 2005 the number of hospitals doubled from 9.800 to 18.700. Because of the
permanent state-of-the-art in city regions the hospital need to import the latest and
expensive medicine technology e.g. MRI and CT scans as well as surgical
equipment. Despite the establishment of the free market economy and the rapid
increase of pure competition the prices for the service soar very fast. The problem is
due to the government that was just focused on the accelerated growth. Beside that
they untended many other areas like the health care system. Over the years the
health care sectors were privatized simultaneous they got the power to increase the
price for services. As a protection against epidemic and pandemic the information
system has been enlarged in many parts of China. Finally the system has been
proved several times against SARS, sea quake and the tsunami in India 2003.
3
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2.3 The health care financing system of China
Before 1980 three different type of health care financing systems were exist in China.
These are the labour insurance medical care scheme, the public service medical care
scheme, and the cooperative medical care scheme. All other inhabitants those are
not covered by the above mentioned schemes have to pay the medical care by
themselves. During the years the labour insurance scheme covered all employees in
state-owned companies and also the workers in collective-owned companies.
The public service medical care scheme has the authority to pay the medical care
consumption of government employees. In rural areas were about 90 % of the
population covered by the cooperative medical scheme. In 1951, the Chinese State
Council stipulated, that all companies with more than one hundred employees should
establish labour insurance. That insurance signifies that the companies should pay
the expenses of their workers. And the employees dependent entitled health to a 50
% refunding of their medical cure costs. In the beginning they budgeted 5.5 % of the
company's total wages for health care costs. Several years later the government
established a new regulation. So the expenditures increased to 15 % since 1980.
17.8 % of the Chinese population were covered through that insurance.
The public service medical care said in 1952 that the government staffs as well as
students are validly to free medical care. The budgeted expenditure until 1980 was
24 Yuan per person and rose in 1984 to 36 Yuan per person. The total expenditure of
the public service medical care scheme was 680 Million Yuan in 1980 and grows up
to 5420 Million in 1990. In 1990, 26.84 Million inhabitants were covered by the public
service medical scheme. It is proofed, that inhabitants covered by the labour
insurance and public service medical schemes have higher medical care utilization,
longer stay at the hospital and higher medical costs per visit as compared with those
who are not covered at all and paying that out of pocket. The expenditure for the
labour insurance coverage in 1980 has a rate of growth about 9.2 % and the
expenditure for the public service coverage has had a rate of growth about 11.1 %.
The other disadvantage of the public service medical scheme and the labour
insurance is their limited ability to spread risk. Because of the huge management of
these insurances at the enterprise or government institution level the enterprise has a
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limited ability to enrage great financial risks. It is for an example not possible to pay
an expensive bill for an employee with disease or cancer. The cooperative medical
scheme released as a result of agricultural collectivization that began in the mid
1950s. In 1970 the cooperative medical scheme had been established in almost 90
% of Chinese villages and became an important position in financing the peasants in
the country sides. In the end of 1970 the Cooperative Medical Scheme collapsed
because of the combination of financial, political and managerial problems. The other
reasons for the weakness were problems in management of the scheme. The
schemes were published without advice from professionals in health planning and
financial management. Some of the cooperative medical schemes are still available
in some parts of China. The provinces have strengthened the schemes by the rural
enterprises and other welfare funds. The increasing heath expenditure has become a
heavy economic problem. The issues of the medical treatment which are paid by the
government and the enterprises are the main source of income for service providers.
Consequently have neither providers of the medical treatment, nor consumer every
stimulus to control consumption of the medical treatment under this insurance
pattern. This is the real reason, why use was higher, more on an average length of
the stay longer and medical costs per visit and admission than those of patients who
pay from the pocket for the medical treatment. Another disadvantage of the working
pattern of the medical treatment of the assurance and civil service is, to some stretch
themselves, her limited ability from to spread out danger. Because the management
pattern mainly in the enterprise or government equipment level, every enterprise of
the equipment has a limited ability to carry big finance dangers like hospital payment
for a cancer patient, for example.
4
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2.4 The healthcare insurance of China
In China are four important health insurance schemes. The basic medical insurance
system for urban residents, the basic medical insurance system for urban employees,
the new rural cooperative medical service, the urban and rural medical relief and the
commercial health insurance. All these insurance schemes are integrated into the
medical security system. In contrast the children's medical insurance is inaccessible
in most of China. Children who are living in the country-side do not belong to the
Urban Health Care System. According to Chinese scholar studies, due to the various
levels of economic development in each area, there are roughly three forms of
children's medical insurance in China which will be mentioned in that chapter.
2.4.1 Basic medical insurance for urban workers
This system is a combination of public health service and labour insurance. It is an
important constitution of national social security system, and also an indispensable in
social insurance. The medical insurance has the properties of social security:
mandatory and mutualisation. So the medical insurance system is usually set up
through states legislation which is carried out by forces. Through fund systems, which
are paid by employer and employee, the government can reduce workers' risk from
illness and working injuries by giving tangible aid. The system of medical insurance
for urban workers has 6 frames. The first is to set up a suitable fare collection
integration scheme. The basic medical insurance is co-paid by the employee units
and individuals, reflecting the compulsory features of state social insurance and the
idea of rights and obligations of unity. The medical insurance premiums are paid by
units and the individuals can expand the source of health insurance funds. More
importantly, that system shows distinct responsibility of the unit and staff and
increases their sense of self-protection. In the recent reform, the government pointed
the state standard contribution rate provided for employers and individuals clearly
out: employers' contribution rate was around 6 % of workers' total wages and
employee contribution rate is generally 2 % of wages.
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The second is to establish general fund and individual account. Basic medical
insurance is constituted of social fund, which is planned by the government as a
whole, and personal accounts, which are used by individuals. All the fees paid by
individuals enter into personal accounts, and about 30 % of the money provided by
enterprises enters also into personal accounts. The rest of the money offered by units
is to establish the social fund. The personal account is especially for each individual,
which also can be inherited. The capital and interest are both possessed by the same
individual. The third is to set a definite system of paying money. Co-ordinate funds
and individual accounts determine the scope of their payment. Co-ordinate fund is to
cover hospital (large) medical treatment costs, personal account pays for the
medical expenses of out-patients' treatment. The co-ordinate fund should have strict
standard of minimum payment and the maximum payment. What else is necessary
than setting up an effective way to manage medical service system? The medical
insurance only pays for medical expenses required in the basic medical insurance
pharmacies directory, clinics items and medical service facilities; which implements
fixed-point management to medical institutions and pharmacies which provide basic
medical insurance services; social insurance institutions and the basic medical
insurance service providers (fixed-point medical institutions and on-site pharmacies)
ought to settle account according to the settlement rules.
At the same time, it is indispensable to establish a unified system of community-
based management services. The basic medical insurance carries out at a certain
level of society to operate. In principle, it is co-ordinated at the level of prefecture-
level cities. The social insurance agencies are responsible for the fund collection, use
and management of the unity, and ensure that the Fund is fully collected, rationally
used and timely paid. Finally it is to establish an improved and effective monitoring
mechanism. The government must guarantee that the basic medical insurance fund
implements a special fiscal account management and the social insurance
institutions establish a sound regulatory system. Moreover, in co-ordinating area the
foundation of the basic medical insurance is consequent and the supervision by
society organizations should be strengthened. These elements are essential for a
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new basic medical insurance system for urban workers. The general frame-work is a
foundation for a unified national system and facilitates the formulation of reform
programs, but also leave space for specific provisions.
5
2.4.2 Basic medical insurance for urban residents
In 1998, China started to build the basic medical insurance system for urban workers,
in order to achieve the objectives that build a basic medical security system covering
the entire population of urban and rural. The State Council decided that from 2007,
the basic medical insurance for urban residents would be carried out in certain
districts. In 2007 the government choose two to three conditional cities to start
experiments. The pilot started 2008 and expands until 2009 up to more than 80 %
nationwide. In 2010, the government will push the process in order to gradually cover
all urban residents in the non-practitioners.
The provisions and management of medical insurance for urban residents
The principle of the pilot
Firstly, the experimental work should begin from a low level, according to various
aspects of economic development and affordability, and set up a reasonable level of
funding and security standards, focusing on the medical needs of the serious illness
of urban residents in the non-practitioner and gradually increasing the protection
level. Secondly, this insurance should adhere to the voluntary principle; fully respect
the wishes of the masses. The third is to clear the responsibility of central and local
governments. The central government sets basic principles and major policies, the
local areas develop specific measures for the administration of insured population.
Lastly, we should stick to the principle of co-ordinating and do well in the
convergence among all kinds of medical insurance system in the basic policies,
standards and management measures.
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The scope of the insured
Primary and secondary school students (including vocational high school, secondary
school, and technical school students), children and other non-practitioners of urban
residents who do not belong to the scope of the basic medical insurance system for
urban employees can voluntarily participate in the basic medical insurance for urban
residents.
Contributions and subsidies
The basic medical insurance for urban residents is paid mainly by family,
accompanied with appropriate government grant subsidies. Residents pay for basic
medical insurance in accordance with the provisions of the insured and enjoy the
corresponding medical insurance. Conditional employers may give the families of the
insured grant. State develops tax incentives rules to encourage subsidies for
individuals and units contributions. The annual per capita subsidy is not less than 40
Yuan for insured residents in pilot cities, of which the central government pay for the
central and western regions by 20 Yuan per capita one year through special transfer
payments from 2007 onwards. On this basis, to families of students and children
belonging to the lowest subsistence security system or severe disabled, the
government gives more than 10 Yuan per capita each year for grant subsidies in
principle, of which the central government gives the central and western regions 5
Yuan per capita for grant. To the rest objects, severe disabilities who lose the ability
to work, and low-income families with 60-year or older people, the government grant
more than 60 Yuan per capita a year, of which the central government grants the
central and western regions 30 Yuan per capita .The finance department of the
central government will provide appropriate subsidies for the eastern region referring
to the granting ways of the new rural cooperative medical care system. The concrete
programs for financial assistance will be determined by the financial department,
labour security department, civil affairs department and other departments. At the
same time, grant funds should be included in the budget of all levels of government.
Abdula Hamed
MEB 7
22
Payment
Urban residents' basic medical insurance fund focuses on medical expense used by
the insured population of the inpatients and outpatients severe illnesses. Areas
where conditions permit can gradually try integrating out-patients' medical costs.
The basic medical insurance pays medical expenses for urban residents within the
provisions of the fund. Other costs can be provided by supplementary medical
insurance, commercial health insurance, medical assistance and social charitable
donations and other means.
Management of system
In principle, medical service management and organizational management of the
basic medical insurance for urban residents is carried out referred to the relevant
provisions of the basic medical insurance for workers. And the fund of urban
residents' insurance is brought into special accounts of the social security funds for
unified management of fiscal accounts.
Under the leadership of the State Council, the basic medical insurance for urban
residents Inter-Ministerial Joint Conference of the State Council, (referred to as the
inter-ministerial joint conference afterwards) is responsible for the organization,
coordination and macro-guidance of pilot work, study and formulate relevant policies,
supervise and inspect the implementation of the policy, review the assessment
experimental work, co-ordinate to solve problems occurring in pilot process, and to
submit a report and recommendations on major issues to the State Council. And the
Labour and Social Security department will develop relevant policies and measures
in conjunction with development and reform, finance, health, civil affairs, education,
drug supervision and Chinese medicine and some other departments. Departments
coordinate with each other according to their respective duties, to accelerate the
process of all the supporting reforms.
6
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- , 2009, The problems of China's Health care system, Hamburg, Bedey Media GmbH, https://www.diplom.de/document/227637
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