PHP9 - Suggestion on Critical Illness Insurance in China

Abstract

Since 2012, China piloted a state-run critical illness cover, which reimbursed for approximately 50% of medical costs. In 2015, Zhejiang Province had taken 15 expensive drugs into the critical illness list, most of these are patented cancer drugs. The article aims to introduce, compare and analyze the design of Zhejiang’s Critical Illness Insurance to conclude the suggestion and prospects. It may provide references to other province, to make this policy more practical and efficiency in China, promoting social health and equality. Followed by the provincial plan published on Feb 2015, The 7 city plans were published from Apr 2015 to Sept 2015. All plans determined that the payment amount will be segmented calculated. The article summarizes and compares the financing level, deductible and cap lines between these cities. 3 cities determined the financing level: 2 cities were from 15 CNY to 40 CNY per capita annually; the rest equaled 0.2% of BMI premium. All cities determined deductible, which calculated deductible based on urban per capita disposable income. All cities determined cap line: 6 cities were from 200,000 CNY to 450,000 CNY and the rest were no cap. 1. Since the central government did not define what critical illness insurance can reimburse, some provincial governments just selected certain disease which public opinion concentrated. While it should be ranked by disease burden 2. The government should pay more efforts on improving reimbursable access not only price control, especially for the exclusive treatment drugs of the same indication but clinical need personalized. However, the main challenge is still how to balance the income and expenditure, besides the financial compensation at all levels, it’s better to have a top-design which could apply the actuarial or pharmacoeconomics tools to make this policy more cost effective and sustainable.