According to the "Statistical Bulletin on the Development of National Medical Security" released by the National Health Insurance Administration, the number of people insured by basic medical insurance in the country in 2022 will be 134.6 billion people, 17.05 million fewer than the previous year, of which 25.17 million people were covered by resident medical insurance. This data has aroused the attention and discussion of all walks of life, why is the number of residents participating in medical insurance declining?How is the standard of medical insurance payment for residents determined?What are the deficiencies of residents' medical insurance for serious illness medical care?This article will analyze and interpret these issues from multiple perspectives.
First of all, the main reasons for the decline in the number of residents participating in medical insurance are as follows:
Changes in the structure of participation. With the development of China's economy and society, new industries, new formats and new models are emerging, and more and more urban and rural residents are participating in employee medical insurance. According to the data of the National Health Insurance Administration, in 2022, the number of employees participating in medical insurance will increase by 8.12 million, while the number of residents participating in medical insurance will decrease by 25.17 million, showing a trend of "declining residents and increasing employees". On the one hand, this reflects the acceleration of China's urbanization process, and on the other hand, it also reflects the relaxation of household registration restrictions for flexible employees to participate in employee medical insurance at the place of employment, which has improved the attractiveness of employee medical insurance.
The quality of insurance participation has been improved. Before the integration of medical insurance for urban and rural residents in 2019, the information systems of medical insurance in various regions were separate and not connected to each other, so there was a situation where some residents may have participated in the NCMS and urban residents' medical insurance at the same time, and some residents participated in the residents' medical insurance in multiple places. These are invalid data of duplicate insurance, which is not conducive to the standardized management and fair distribution of medical insurance. Since the establishment of the National Health Insurance Administration, it has continued to promote the direct settlement of medical treatment in other places, and used information technology to clean up duplicate insurance data, which has reduced the number of people by more than 40 million. Especially after the launch of the national unified medical insurance information platform in 2022, the national medical insurance data will be fully interconnected, the settlement of medical treatment in different places will be more convenient, and the phenomenon of duplicate insurance data will be more obvious. In this way, the data of residents' medical insurance participation will more truly reflect the insurance situation, and it will also be more conducive to improving the efficiency and fairness of medical insurance.
Willingness to pay is decreasing. Although the participation rate of residents' medical insurance remains above 95%, there are still some residents who give up or default on paying due to factors such as payment burden, reimbursement treatment, and convenience of medical treatment. Some low-income families, rural residents, flexible workers and other groups may think that they are in good health and do not need medical insurance, or that the level of protection of medical insurance is not high and not cost-effective, or that the payment and reimbursement procedures of medical insurance are too complicated and inconvenient, so they choose not to participate in insurance or pay in time. All these have affected the number of people enrolled in the resident medical insurance and the coverage of the medical insurance.
Secondly, the determination of the payment standard of residents' medical insurance mainly includes the following considerations:
Medical protection needs. The payment standard of residents' medical insurance is carried out in accordance with the fixed financing model of combining financial subsidies and individual contributions, and is dynamically adjusted every year. With the development of economy and society, the wide application of new medicine and new technology in China, the people have put forward higher demands for medical security, including the reimbursement level of medical expenses, the scope and content of medical security, etc. Therefore, the improvement of the financing standard for urban and rural residents as a whole is also to better meet everyone's needs for medical security. At the same time, in order to ensure the sustainable development of residents' medical insurance, it is also necessary to adjust the payment standards in a timely manner according to the growth of medical expenses and the expenditure of medical insurance** to maintain a balance between revenue and expenditure.
Financial subsidy. In the financing of residents' medical insurance, financial subsidies have always accounted for the main proportion, and it is also continuously increased with the improvement of individual payment standards. From the initial 20 yuan per person per year, to 2023, the financial subsidy will not be less than 640 yuan per person per year, and the financial subsidy is very large. According to the data of the National Health Insurance Administration, in 2022, the financial subsidy for residents' medical insurance will be 63557.7 billion yuan, equivalent to 646 yuan per capita financial subsidy for residents with medical insurance. This also reflects the country's attention and support for residents' medical insurance, and provides a strong guarantee for the development of residents' medical insurance.
Differences in insured groups. At present, the payment standard of China's residents' medical insurance is to pay a fixed amount and equal premiums according to capitation, which has led to the problem that some low-income families and rural residents have an excessive payment burden, while some middle- and high-income families and urban residents have too light payment burdens. This payment mechanism does not fully consider the differences in the income level, medical needs, and payment ability of the insured groups, nor is it linked to indicators such as residents' disposable income, and lacks an automatic adjustment mechanism, which is not conducive to the fairness and efficiency of medical insurance. Therefore, it is necessary to reform the payment mechanism of residents' medical insurance, introduce differentiated payment standards, and let those who have the ability to pay more and those who have difficulties pay less, so as to realize the function of income redistribution.