Abstract
BackgroundThe simultaneous improvement of the security capability of China Health Insurance System and its development in the last decade remains uncertain. This study measures the status and trends of reimbursement levels of the China Health Insurance System, as well as to offer policy advice to subsequent insurance reforms.MethodsThe National Reimbursement Ratio was created to determine the reimbursement level of the national health insurance system based on total health expenditure and the covered population. Chinese total health expenditure data from 2004 to 2011 were extracted from China’s Health Statistics according to the standards of the International Classification for Health Accounts by Healthcare Financing.ResultsIn 2011, the medical expenditure per capita in China was USD 130.95 and the National Reimbursement Ratio was 26.39%. The National Reimbursement Ratio showed an intense transition from 2004 to 2011, with a sharp decrease from 98.51% in 2004 to 22.44% in 2009, and then a small increase to 26.39% in 2011.ConclusionThe National Reimbursement Ratio was effective in revealing the reimbursement level of the national health insurance system and in predicting its trends. The challenge to China’s healthcare reform is to switch from increasing insurance coverage to guaranteeing a steady increase in government input and building a powerful supervision mechanism.
Highlights
The increase in social health insurance coverage in China from less than 15% to more than 95% in 2011 took about 10 years [1]
The National Reimbursement Ratio was created to determine the reimbursement level of the national health insurance system based on total health expenditure and the covered population
The National Reimbursement Ratio (NRR) is defined as the ratio of the reimbursement per capita for people covered by all health insurance systems (HIS) compared with the medical expenditure per capita (MEPC) for the whole nation, reflecting the average reimbursement level of the entire China Health Insurance System (CHIS)
Summary
The increase in social health insurance coverage in China from less than 15% to more than 95% in 2011 took about 10 years [1]. A realistic limitation of this indicator is that as the territorial government expenditure on healthcare occupies a larger proportion of THE in the Health Accounts, enlarging the territorial government expenditure on healthcare could lower the ratio of OOP to THE but it might not reflect a potentially improved financial protection. One of the major objectives of most health insurance systems (HIS) is to increase the reimbursement level of patient expenditures, at least in those systems in which patients are paying for services OOP [5,7]. The key social function of health insurance is its ability to determine access to medical care and to share part of the financial risks with patients and their families [8]. This study measures the status and trends of reimbursement levels of the China Health Insurance System, as well as to offer policy advice to subsequent insurance reforms.
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