In the face of the reality of the decline in the number of insured people, it is necessary to make concerted efforts to optimize the cost of individual insurance and continue to improve the security capacity of NCMS.
Data map. Photo: Xinhua News Agency.
Beijing News editorial.
According to China News Weekly, medical insurance bureaus in many places across the country have recently issued notices on medical insurance premiums for urban and rural residents. A corresponding background is that, according to the data released by the National Health Insurance Administration, the number of people participating in medical insurance for urban and rural residents across the country has gradually declined since 2019. In 2022, the number of urban and rural residents participating in medical insurance will decrease by 25.17 million compared with 2021. In this regard, a number of experts said that the individual payment of medical insurance for urban and rural residents has been increasing year by year, which has affected the enthusiasm of residents to voluntarily participate in insurance.
The new rural cooperative medical system in the mouth of rural residents actually refers to the basic medical insurance system for urban and rural residents established after the integration of the two systems of urban residents' medical insurance and new rural cooperative medical care in 2016. The decline in the number of participants in NCMS is not the first time it has attracted attention. In recent years, there have been more and more controversial collection methods in various places, and the payment time has been extended, which is a direct signal.
However, it is not comprehensive to attribute the decrease in the number of insured people to a decline in willingness to pay. The relevant person in charge of the National Health Insurance Bureau once explained that this is not only related to the change in the insurance structure, but also because of the improvement of the quality of insurance. In addition, there may also be an impact of the total population decline in the past two years.
However, it is undeniable that the enthusiasm of rural residents to participate in insurance has declined, which is an important factor in the change in the number of insured people. Some village cadres said that the number of local people who have not paid the NCMS is increasing year by year, and the townships with the highest proportion of unpaid people may account for about 30. Behind this, the significant increase in premiums is a realistic background that cannot be ignored.
In 2003, when NCMS was established, the individual payment standard was 10 yuan, and by 2023, it has risen to 380 yuan. In other words, in 20 years, the individual premiums of NCMS have increased by 37 times. Taking a rural family of five as an example, the annual premium is close to 2,000 yuan, which is a big test for the family's financial affordability. One data that can be referred to is that the median per capita disposable income of rural residents in the country in 2023 is only 18,748 yuan.
The enthusiasm of residents to participate in insurance is linked to personal health and family risk resistance, and even social stability, and the sustainability of the medical insurance system on the other. At this time, an important countermeasure is to make concerted efforts to optimize the cost of individual insurance participation and continue to improve the security capacity of NCMS.
On the one hand, it may be advisable to postpone the increase in individual premiums. In fact, during the two sessions of the National People's Congress in 2022 and 2023, some deputies suggested that "the increase in the individual payment standard of basic medical insurance for urban and rural residents should be reasonably controlled, and the standard should be increased once every 3 to 5 years". In this regard, the National Health Insurance Administration also replied that it will promote the adjustment of residents' medical insurance contributions to be linked to the level of social development and the per capita disposable income of residents. The development and implementation of measures in this regard may be accelerated.
It should be noted that in the past few years, affected by the epidemic and other factors, the income and expectations of some residents have changed, and the timely postponement of the increase in the insurance standard is an accurate response to the social affordability, and is also conducive to releasing the signal of "overcoming difficulties together", reflecting the medical insurance system's compassion for people's livelihood.
On the other hand, the medical insurance reimbursement system should be optimized to enhance the "sense of gain" of residents' participation in insurance. One reality that needs to be faced is that according to the current reimbursement system, the grassroots hospitals with the highest reimbursement ratio are often unable to treat "serious diseases", while the reimbursement ratio of large hospitals is low, which causes the actual expenditure cost of the insured to remain high.
This system design takes into account the need for guidance for hierarchical diagnosis and treatment, but it also objectively weakens the real "sense of gain" of the insured. How to balance the practical needs in this regard and effectively improve the ability to protect against "serious diseases" is worth comprehensive consideration.
Of course, whether it is a reasonable sharing of the cost of individual insurance, or a significant improvement of residents' "sense of access" to medical insurance, the best protection of medical insurance funds is the key.
Not long ago, the National Health Insurance Administration made it clear that in order to consolidate and expand the coverage of residents' medical insurance, the state will arrange special policies to support all residents on the basis of financial subsidies for inclusive insurance, according to local financial resources and the affordability of different individuals. This is undoubtedly good news. In recent years, "using money on the cutting edge" and taking people's livelihood as the focus of fiscal expenditure is also becoming a consensus at all levels.
In this context, it is advisable to give higher priority to increasing investment in medical insurance such as the New Rural Cooperative Medical System.
Edited by Xu Qiuying.
Proofread by Jia Ning.