1. Exploration and Prospect of China medical security system reform Zhang Xiaojie Sociology department of SAI 2014.6

2. 2 Backgrounds  Health care reform is a worldwide problem, China is also plagued by this problem  China's health care system in medical service supply mechanism and medical management made a lot of exploration  Marketization of medical security and medical service is the core issue of health care reform

3. 3 Main content Exploration of China's medical security system reform Current problems Prospects 3 3 2 2 1 1

4. 4 1. Exploration Reform process 1.1  The first stage (1951-1984) : Free medicare ；  The second stage (1984-1997) : a market-oriented health care reforms ；  The third stage (1997-2009) : the marketization of medical treatment and problems ；  The fourth stage (2009 - present) : the new health care reform and comprehensively deepen market-oriented reform

5. 5 1. Exploration Reform process The new health care reform:  From 2009 to 2011:  Universal coverage of basic medical insurance;  National essential drug-list system; Basic medical and health service system;  Universal access to basic public health services;  Trial reform of public hospitals;  By 2020, the establishment of basic medical and health system covering both urban and rural residents, everyone will have access to basic medical and health services 1.1

6. 6 The planned economy Free medicare system Labor medicare system Rural cooperative medical system Two pilots Market economy Expansion of trials Medical insurance for urban workers New Rural Co-operative Medical System Medical insurance for urban residents Universal health care system 1. Exploration

7. 7 Medical assistance system New Rural Co-operative Medical System Basic medical insurance for urban workers Medical insurance for urban residents Civil serv ants Large medicaid enterprise Commercial health insurance Foudation Man body Supplement Rural population Urban population Present framework

8. 8 Development of the medical security system 1. Exploration FormCoverageRatioSecurity level MIU-W2.65 billion 1/3 （ In urban population ） High, but some people only for a serious illness NCMS8.02 billion A complete coverage Basic only serious illness, actual reimbursement ratio is about 30% MIU-R2.72 billion 50% of the city reimbursement ratio slightly higher than the NCMS MAS0.22 billion symbolic system  Expanding coverage 1.2

9. 9 Development of the medical security system 1. Exploration 2006200720082009201020112012 Number(billion)4.107.268.158.338.368.328.05 Rate (%)80.786.291.594.296.097.598.3 Per capita financing(RMB) 52.158.996.3113.4156.6246.2308.5 fund expenditure(billion RMB) 155.8346.6662.3922.91187.81710.22408.0 Benefit people (billion) 2.724.535.857.5910.8713.1517.45 NCMS 1.2

10. 10 Development of the medical security system 1. Exploration MIU-W 1.2

11. 11 2. Current problems Fragmentation and differentiation of medical security system 2.1  Fragmentation ： Division of urban and rural system, Separation of management system, four different kinds of medical insurance system coexist  differentiation ： According to the different types of health care, the security level gap is obvious  Medical insurance plan as a whole level mainly stays in the county, the management of the medical insurance and reimbursement process is very complicated.

12. 12 2. Current problems Expensive and difficult  The medical service market dominated by the supplier, medical costs rising too fast  Too much personal cash payments, insurance payment proportion is too low  Most of the urban and rural residents depend mainly on personal and family power to resist disease risk, low population could enjoy medical insurance 2.2

13. 13 Government health expenditure Social health expenditure Personal expenses 20.4% 45.2% 47.4% 34.5% 32.2% 20.3% 数据来源：中华人民共和国卫生部： «2008 中国卫生统计年鉴 » ， 2009 年卫生部报告 The proportion of medical expenses

14. 14 TypeNumber (billion) Rate (%)Per capita health expenditure (RMB) Per capita insurance (income) (RMB) The proportion of insurance cost % MIU-W 2.116%1,337 970 （ 1,293 ） 72% MIU-R 18%1,337 170 (200) 13% NCMS 8.161%565 85 (100) 15% No insurance (including free medical care) 2.116%92000 Total 13.3100%920

15. 15 2. Current problems Medical insurance institutions did not play the role of third party supervision  Health insurance is merely act as the role of the third party payment  As the largest buyer of medical treatment insurance, who was not involved in the whole process of medical services and medical service cost price formation. 2.3

16. 16 2. Current problems Major differences still exist in the reform  The "general health" can be regarded as private consumption goods?  The focus of the medical security is confirmed a serious illness or common disease and frequently-occurring disease?  The financing mode of medical security should choose insurance, or fiscal budget?  The government subsidies suppliers or the demand side?  Medical service resources configuration can rely mainly on the market?  Medical service institutions can give priority to with the for-profit sector?  How to protect the interests of the medical staff and how to implement incentive? 2.4

17. 17 3. Prospects Cohesion and integration of medical security system 3.1  First, all kinds of medical insurance can seamless connect, the insured persons can achieve barrier-free conversion between urban and rural areas, between different regions  Secondly, the establishment of administrative management system of unified management of urban and rural security system  Thirdly, we will establish a unified, efficient financing mechanisms and cost control mechanism  Finally, gradually reducing the gap between different populations basic treatment, improve the level of security

18. 18 3. Prospects Build a reasonable fund-raising system, improving the quality of medical services 3.2  The core of Medical security is fund-raising and service supply  Financing is to maintain the basic medical insurance level and an important factor of sustainable  Improving the quality of medical services  Upward focus of information, service of passed down

19. 19 3. Prospects The ratio of the cumulative balance with the spending

20. 20 3. Prospects Comprehensive reforms in medical field  Comprehensive reforms include: medical security system reform, medical and health system reform, the medicine circulation system reform  MI-HA: Medical institutions and health authorities  MI-DS: Medical institutions and drug suppliers  MI-Mi: Medical institutions and medical insurance 3.2

21. 21 The interests of the relationship between three main is too complex and difficult to separate and supervise each other HA DS Mi MI Patient Insured person

22. 22 3. Prospects  A lot of investment for the construction of hardware facilities and the acquisition of expensive medical equipment ；  Input costs to patients, not only wasteful, also increased the burden of patients

23. 23 3. Prospects The interests of the separation MI from HA,DS,MI 3.2 Comprehensive reforms in medical field HA DS MI Mi Patient Insured person

24. 24 3. Prospects  Health care reform itself is a process of constant development and improvement  Health care is essentially a huge financial problems, faced with fiscal sustainability challenges in the future

25. Thank you Zhang Xiaojie( 张晓杰 ) 18918211887 E-mail: sdxzxj@163.com