China Achieves Nationwide Health Insurance Network by End of 2016, Launches Cross-Provincial Inpatient Direct Settlement in 2017
On December 13, Huang Huabo, Deputy Director of the Social Insurance Administration Center under the Ministry of Human Resources and Social Security, announced that China would basically achieve nationwide networking of medical insurance by the end of 2016, while simultaneously launching the direct settlement of inpatient medical expenses for retirees resettled across provincial boundaries.
Huang Huabo made these remarks at a press briefing held by the Ministry of Human Resources and Social Security to announce that the Chinese government had received the “Outstanding Achievement Award in Social Security.” He stated that the national system for cross-provincial medical expense settlement has currently passed its preliminary acceptance inspection.
Huang Huabo stated that in 2017, China would begin to gradually implement direct settlement of inpatient medical expenses for retirees resettled across provincial boundaries, with the policy expanded by year-end to cover direct settlement of inpatient medical expenses for patients receiving out-of-province care in accordance with referral regulations.
Meanwhile, in conjunction with reforms to the local household registration (hukou) and residence permit systems, individuals residing long-term outside their place of household registration and employees stationed long-term in other regions will be gradually included in the coverage for direct settlement of inpatient medical expenses incurred across different regions.
On December 9, the Ministry of Human Resources and Social Security and the Ministry of Finance jointly issued the “Notice on Doing a Good Job in the Direct Settlement of Inpatient Medical Expenses for Cross-Provincial Medical Treatment under Basic Medical Insurance.” The document clarifies key issues such as objectives and tasks, basic principles, major policies, settlement models, operational procedures, responsibilities of the national-level and provincial-level platforms, and the development of information systems. Last week, the National Cross-Regional Medical Expense Settlement System passed its preliminary acceptance inspection.
With only a dozen days left until the end of 2016, news emerged that the nationwide interconnection of medical insurance systems was imminent. In fact, multiple policies and announcements regarding the nationwide networking of medical insurance had already been released in 2016. VCBeat (WeChat ID: vcbeat) has compiled this year’s news from the Ministry of Human Resources and Social Security concerning the nationwide settlement of medical insurance.
On April 22, 2016, Li Zhong, spokesperson for the Ministry of Human Resources and Social Security (MOHRSS), stated at the ministry’s first-quarter press conference: “In 2016, we will achieve direct settlement of inpatient expenses for retirees residing outside their home regions. By 2017, we will basically realize direct settlement of inpatient medical expenses incurred outside their home regions for insured individuals who meet referral criteria.”
Li Zhong stated that the current status of direct settlement for cross-regional medical insurance is as follows: 30 provinces and municipalities have achieved networked connectivity for intra-provincial cross-regional medical care, among which 27 provinces and municipalities are capable of directly settling inpatient expenses for such care.
Regarding the issue of cross-provincial medical treatment for insured persons seeking care outside their home province, Li Zhong stated that this is the concern most strongly voiced by the public and also the most challenging to address. To achieve the goal of basically enabling direct settlement of inpatient medical expenses for insured individuals who meet referral criteria by 2017, the Ministry of Human Resources and Social Security will take measures in three areas: accelerating the development of a national-level system for direct settlement of cross-provincial medical expenses; guiding local authorities in carrying out related work on cross-provincial expense settlement, with particular emphasis on further strengthening and improving intra-provincial settlement systems and ensuring their integration with the national ministry-level system; and collaborating with relevant departments to study further improvements to the revolving fund mechanism and the tiered diagnosis and treatment system, including policies to enhance supervision of medical services.
In late May 2016, Huang Huabo, Deputy Director of the Social Insurance Center under the Ministry of Human Resources and Social Security (MOHRSS), revealed during an online interview on accelerating the nationwide networking of medical insurance that the MOHRSS would launch the development of the corresponding “Golden Social Security Project Phase II” system—namely, the nationwide medical insurance networking system—as early as June. He also disclosed that rural residents participating in the New Rural Cooperative Medical Scheme (NRCMS) are expected to benefit from networked cross-regional settlement for medical services.
Huang Huabo stated that, given that some regions have already completed the integration of urban and rural resident basic medical insurance, coverage can be achieved in these areas. For regions where integration has not yet been completed, the human resources and social security departments will further coordinate with other relevant departments in the next steps.
Huang Huabo cited an example: For participants in the New Rural Cooperative Medical Scheme (NRCMS) in their place of insurance coverage who seek medical treatment in areas without the NRCMS, the currently proposed preliminary solution is to enable information exchange between the NRCMS information system and the social insurance system in the place of insurance coverage, and then leverage the two-tiered provincial and national networked settlement systems and settlement centers to achieve cross-regional transmission of medical treatment information and direct settlement.
On October 9, 2016, the Ministry of Human Resources and Social Security issued the “Notice on Deepening the Study and Implementation of the Spirit of the National Health and Wellness Conference,” emphasizing the need to accelerate the integration of basic medical insurance systems in urban and rural areas. It aimed to ensure that all provinces (autonomous regions and municipalities) would release their integration plans by the end of the year, with a unified basic medical insurance system for urban and rural residents to be established starting in 2017.
Accelerate the nationwide networking of basic medical insurance and the direct settlement of medical expenses for off-site medical treatment, ensuring that by next year, direct settlement of hospitalization expenses for retirees resettled across provinces is basically achieved, and by the end of 2017, direct settlement of hospitalization expenses for off-site medical treatment in accordance with referral regulations is basically realized. Improve the mechanism for medical insurance administration, innovate service models, promote the formation of a diversified competitive landscape, and enhance the efficiency and quality of basic medical insurance administrative services.
Currently, 20 provinces have explicitly integrated urban and rural basic medical insurance schemes. It is reported that China’s basic medical insurance system primarily consists of three types: Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and the New Rural Cooperative Medical Scheme (NRCMS). Among these, the Urban Resident Basic Medical Insurance is funded by government subsidies and contributions from urban residents, and is administered by the human resources and social security departments. The NRCMS is funded by government subsidies and contributions from farmers, and is managed by the health and family planning departments. Although both the Urban Resident Basic Medical Insurance and the NRCMS combine individual contributions with government subsidies, differences in administrative authorities have led to variations in reimbursement policies, drug formularies, and other aspects, resulting in significant disparities in the benefits enjoyed by participants.
According to the Ministry of Human Resources and Social Security on the 8th, a total of 20 provincial-level regions across China—including Beijing, Tianjin, Hebei, Inner Mongolia, Shanghai, Zhejiang, Jiangxi, Shandong, Henan, Hubei, Hunan, Guangdong, Guangxi, Chongqing, Yunnan, Shaanxi, Qinghai, Ningxia, Xinjiang, and the Xinjiang Production and Construction Corps—have either formulated overall plans for establishing a unified basic medical insurance system for urban and rural residents or have fully achieved integration.
The current medical insurance reimbursement system acts as an invisible barrier affecting a special group—patients seeking medical care outside their home regions. Common challenges they face include non-reimbursable expenses or low reimbursement rates, lengthy out-of-pocket payment periods, the need for multiple trips, and cumbersome procedures. News from the Ministry of Human Resources and Social Security regarding the nationwide networking of medical insurance, released in April, June, October, and now December, indicates that technical and policy-related developments are progressively addressing and advancing this initiative. Against the backdrop of increasingly frequent population mobility in China, real-time settlement for cross-regional medical care is imminent, and medical insurance “roaming” will likely soon become a thing of the past.