The ongoing health insurance reform will not change the attribution of personal accounts, while offering three major benefits to insured residents such as supporting the reimbursement of general outpatient bills, an official from the National Healthcare Security Administration (NHSA) said on Saturday.
Analysts noted that the reform doesn’t mean any curtailment of the benefits for insured people, which will utilize the fund from personal accounts more efficiently, especially for elderly people who normally incur higher medical expenses.
Responding to some public concerns regarding the reduced amount deposited each month into personal accounts, the official said that the reform is to adjust the contribution from employers to personal accounts as a “replacement” to support the reimbursement of general outpatient bills.
The reform will provide the outpatient reimbursement for more areas previously without the benefits while increasing the reimbursement levels for areas already covered.
The attribution of the personal accounts will remain unchanged and the payment made by employees themselves will still flow into each holder’s personal accounts, while retirees do not need to pay for personal accounts.
In terms of the changes for employees, money deposited by employers into their personal accounts will be directly paid to the pooled fund for outpatient reimbursement instead of placing into personal accounts after the reform. The amount of deposit to retirees’ accounts will be adjusted based on changes of standards.
The nation’s health insurance system includes mandatory personal accounts with contributions from both employees and employers that mainly pay for ordinary outpatient services. It also consists of a pooled fund contributed by employers which is used to reimburse hospitalization bills, outpatient bills for serious illnesses, and expenses for some chronic diseases.
The official said the reform involves the adjustment of benefits, and many participants will have different degrees of reduction in the funds allocated to their personal accounts, adding that responsible authorities are stepping up efforts to promote the policy convergence before and after the reform.
The new outpatient reimbursement mechanism will actually enhance the benefits for insured people by better utilizing the fund rather than cutting the benefits, Wang Chaoqun, associate professor from Department of Labor and Social Security at Central China Normal University, told the Global Times on Saturday.
Wang noted that many elderly people have a higher demand for outpatient services while the medical expenses can’t be covered by the fund from personal accounts. Meanwhile, the funds may remain idle in people’s accounts who have less of a need for immediate medical treatment.
The reform will overall elevate the whole operating efficiency for the health insurance system, Wang said.
The reform raises the minimum reimbursement percentage for outpatient medical bills to 50 percent, while mandating efforts to further tip the scales of policy in favor of retired people, according to the Xinhua News Agency on Friday.
The report noted that retired people in Hohhot, North China’s Inner Mongolia Autonomous Region, can now have up to 6,000 yuan ($870) of their outpatient bills reimbursed, which is 2,000 yuan more than the limit they used to enjoy. The city added 5 percent to the standard reimbursement ratio of outpatient bills for retired people while raising the upper limit for the collective fund to cover the outpatient bills for them.
In addition to support the reimbursement of general outpatient bills, the reform will further utilize the medical resources targeting difficulties in getting hospitalized treatment and expand the usage of personal accounts to family members.
In 2022, the outpatient reimbursement system covered 108.6 billion yuan for insured people, according to the official from NHSA. Since 2023, the designated medical institutions across the country have achieved a coordinated settlement of 441 million general outpatient visits, with an average daily settlement of over 7.8 million visits and a settlement amount of 46.24 billion yuan.
(Global Times)
