Study On Financing Feasibility Of National Basic Medical Insurance In The Situation Of Urban-Rural Integration

BackgroundThe new medical reform program proposes to establish and improve the basic medical insurance system for all urban and rural residents by basic medical insurance of employees, new rural cooperative medical system(NRCMS) and basic medical insurance of residents. From the policy level, almost everyone can find their corresponding medical insurance system in the framework of current medical insurance systems. But it can not be called real universal health insurance if all people only be covered by system and policy. Moreover, the current medical insurance systems have some problems which can not be overcome by themselves.Firstly, the current medical insurance systems have obvious characteristics of urban and rural. There are major differences between the current systems, which are difficult to merge and integrate and do not meet the circumstance requirements of socio-economic integration development in urban and rural and the household register system refom. Secondly, different people enjoy different security benefits. It enlarges the medical service difference between the urban and rural residents and does not meet the requirement of health-equity theory. Thirdly, different medical insurance systems are in charged by different departments. It increases the cost of management and management difficulties, causes the convergence difficulty between several systems, does not meet the principle of efficiency and need for further reform and improvement. From the own development of medical insurance, we should transfer the current medical insurance systems from multiple systems to the single system, shorten the difference of three major systems, cancel the system border, realize the integration of different policies, or build a unified basic medical insurance system with universal coverage to achieve the target of "universal coverage".The existing studies about national basic medical insurance (NBMI) focus on the orientation of system development, the possibilities of system integration, the characteristics and principles should be followed. There is no summary and a clear concept and definition about NBMI. The current studies about financing were concentrated on financing methods, financing models, financing level, financing indexes etc. There are a few qualitative analyses about financing on NBMI recently but no quatitative study. The financing mechanism should be calculated and analyzed including how to finance, how many should be funded, what channel, how about the financing capacity etc.The main purpose of this study is to clarify the concept and features of NBMI, answer how to finance, how to determine the funding criteria, compensation criteria, funding limits and financing subjects, analyze the affordability of financing, financing feasibility and political, system, social situation, decide that if our country has the condition to run the NBMI, study those areas which have already implemented NBMI to obtain some references, clarify the problems that will be found in our implementation of NBMI and propose corresponding solutions and policy suggestions.Study methodsStudy uses qualitative and quantitative methods. We definite the conception of NBMI, propose corresponding institutional framework by qualitative research, primarily through literature review and expert consultation. We use the relative data from National Ministry of Health, Ministry of Finance, National Bureau of Statistics and other authoritative agencies to calculate the funding. According to the principle of "expenses determining revenue", we use the ILO model to estimate the medical expenses. The other indicators (insurance factor, compensation ratio, risk funds etc.) in the process are determined by literatures and expert advices. Microsoft excel software is used to arrange and calculate data. In every step of the calculation, we compare and testify the results with the existing datas or literatures to ensure that the results are scientific and rational.Main study results1. In this study, NBMIS is summarized and definited by the literature analysis, expert consultations and related theories, including health equity theory, underline equity theory, medical insurance theory, system transferrence theory, route depending theory etc. NBMIS is a system made by our government to ensure the basic health equity of all residents and ensure them to obtain basic medical services equally. NBMIS is a system to provide financing protection and risk sharing and improve health financing fairness. From the operation aspect, NBMIS services for all the people, possesses welfare feature, is a united system with multi-level. All people must attend NBMIS free form identity and geographical constraints. They can select appropriate compensate packages voluntarily according to their income and affordability. The residents access to basic health care services in accordance with the compensation packages they chose accordingly. In the same way, urban and rural use one institutional framework together, the management of services achieves reunification in urban and rural areas, the treatment standards achieve consistent in urban and rural areas. The goal is to expand the insurance coverage to all people and increase the risk-sharing capacity.2. According to the actuarial principle, study estimates the amount of funding needed to operate the NBMIS at the basis of 2008 national medical expenses. Taking into account the economic capacity of residents in different areas, study imitates four compensation packages in one system framework. The compensation range is:inpatient compensation 50% to 80%, outpatient compensation 30% to 60%.The results show that at the national level, the amount of funds required for the four compensation packages are 373.519 billion yuan, 526.646 billion yuan,707.294 billion yuan and 913.169 billion yuan respectively, which is afforded by residents and government together. If the residents take 30% and the government takes 70%, then the residents need fund 112.0557 billion yuan,157.9938 billion yuan,212.1882 billion yuan and 273.951 billion yuan, which is 0.813%,1.15%,1.54% and 2% account of income level respectively. The government needs fund 261.46 billion yuan,368.65 billion yuan,495.11 billion yuan and 639.22 billion yuan, which is 0.83%,1.17%,1.58% and 2.04% account of GDP in 2008 respectively.3. In recent years, the residents'revenue is improving, and the deposit is growing. In this situation, if. the residents have funding desire, coming up with 0.8% of revenue to participate in the medical insurance of "low-level, universal coverage" should not be a problem.4. In the recent years, the economy index is growing quickly and steadily in our country, which is a good economic foundation for NBMIS. China's tax revenue increased 841.3 billion yuan over the previous year in 2008. From a data perspective, if the central government can come up with 20% to 30% of the state's tax revenue growth, can we reach the target of "low level, universal coverage". There indeed is certain difficult if we want to achieve a high standard of compensation package and reflect the benefits characteristics of NBMIS. However, the total health expenditure in China accounted for the proportion of GDP has not yet reached WHO requirement of 5%, that is to say, our government should strengthen the health inputs further. If we can increase inputs, make the scientific stock adjustment at the same time and grasp the funding direction, NBMIS of a high standard is not unexpected from our current economic strength.5. From macroscopy respect, our country has possesses the basic condition to build NBMIS including social condition, policy condition, economy condition and system support. But from the microscopy respect, there are many problems, including system construction, organization installation, financing operation, management cooperation, human resources etc. So we can not reach NBMI in a short time, we need carry out the NBMIS step by step.6. Through the demonstration study in some regions, which have already implemented the NBMI, we analyze the condition that should be reached to operate the NBMI smoothly. Such as the following requirements:①shortening the gap between the various systems to achieve the convergence of medical insurance systems in urban and rural;②setting different compensate levels according to the actual situation to achieve universal coverage;③building a unified and perfect management institution;④having a sound, efficient and capable health service system in both urban and rural;⑤having strong political and social advantages.Conclusion and policy suggestionsNBMI is an inevitable choice in the reform of medical insurance system, also in line with the development trends of health insurance in global societies. China's economic level is growing rapidly and steadily, the people are calling for improving the treatment of health insurance, the social security system'is being completed, these advantages indicate that we have already had the circumstance to carry out the NBMI. Because of recent manage mechanisms and systems, we need certain transition period. During this period, we should understand the impediments of transferrence (or the problems) fully, note the coordination of policies and mechanisms, so as to merge at an appropriate time.According the results, we make the following advices:(1) increase government investment, adjust the structure of government spending and give greater priority to basic medical care, strengthen the coordination mechanisms between various departments at the same time; (2) advance the inter-system integration and inter-agency integration gradually, strengthen the link with the medical aids system so as to decrease the poverty due to sickness. (3) strengthen institutional publicity, ensure the benefits degree, improve the willingness of financing, and seek understanding and support from the stakeholder groups; (4) improve the financing level to provincial(municipal) level at least, fully reflect the significance of regional aims at treating; (5) strengthen the legislative process, establish a stable and efficient fund-raising mechanism; (6) develop different medical insurance systems based on different special situations of regions and groups in a short time, select different models according to the difference of socio-economic conditions (eastern, middle and western of china) and their demands at present.