The progress of the New Rural Cooperative Medical Scheme (NRCMS) in 2013 and major tasks in 2014

(chinadaily.com.cn)

Updated: 2014-06-03

The progress of the NRCMS in 2013

In 2013, the New Rural Cooperative Medical Scheme ran smoothly. Management and the overall system was improved, covering a large rural population that enjoyed more benefits, especially with a higher level of medical insurance for serious illnesses.

The financing and security level was improved, further benefiting rural residents. By 2013, a total of 802 million people nationwide were covered by the NRCMS, accounting for 99% of the whole population. Funds raised reached 370 yuan ($59.45) per capita, increasing by 62 yuan from the year before. The reimbursement rate for hospitalization expenses covered by relevant policies exceeded 75%, and the real compensation ratio continued to increase – nearly 80% at the town level, over 60% at the county level and over 50% at the clinic, benefiting about 1.94 billion people with a year-on-year growth of 11.3%.

A multilevel and multiform preliminary security mechanism for major illnesses has also been established. First, security mechanism for serious illness focusing on the type of disease was consolidated and improved. In 2013, two more diseases, childhood phenylketonuria and hypospadias, were included into the scope of medical insurance for major illnesses apart from 20 diseases such as childhood leukemia and congenital heart disease. About 1.99 million patients received reimbursements, and the real compensation ratio for 22 types of diseases reached 69%, largely reducing their financial burden. Second, the NHFPC actively encouraged buying major illness insurance by using the funds of the NRCMS. In 2013, about 28 provinces developed implementation plans for major illness insurance. Up to 1.23 million patients received compensation and further relieved their burden.

Management and services were also improved. First, management and service were further commissioned to the society, helping transform the functions of the government. Now, up to 24% of counties, districts or cities have commissioned commercial insurance companies to operate the NRCMS, the medical expenses reimbursement process was further facilitated. Rural residents participating in the new system in over 88% of areas nationwide are now able to get immediate reimbursement anywhere in their province. The national NRCMS information platform has connected with nine provincial platforms and several large medical institutions, which makes inspection of trans-provincial medical expenses possible and also paves the way for the pilot program of trans-provincial medical expenses reimbursement. Third, a reform in payment method has been deepened, covering over 80% of areas nationwide and helping curb soaring medical expenses to some extent.

Major tasks of the NRCMS in 2014

According to the tasks of the health care reform, the NHFPC will continue to develop and improve the NRCMS on the basis of urban-rural overall development of medical insurance.

First, to further enhance the financing standards and security level of the NRCMS, maintain a participation rate of the NRCMS of above 95%, increase annual subsidies to 320 yuan per capita, optimize and coordinate a compensation scheme, and keep the reimbursement rate for medical expenses covered by relevant policies at 75% and outpatient expenses at 50%.

Second, to should improve the medical security mechanism for various major illness in the NRCMS, continue the security mechanism for 22 serious diseases including childhood leukemia, expand the security mechanism to more than half of the areas covered by the NRCMS, and take full advantage of the system based on types of disease and expenses. We should also establish a preliminary mechanism of disease emergency rescue and coordinate with basic medical security, serious illness insurance for urban-rural residents and medical assistance.

Third, to encourage more commercial insurance companies to operate the management and service of the NRCMS and serious illness insurance. We should improve the management and service and set up a multilevel security mechanism for serious illness by taking advantage of both the government and market.

Fourth, to accelerate the informatization construction of the NRCMS, improve the service of immediate reimbursement within a province, continue the construction of national and provincial information platforms, and expand to 15 provinces that can connect to national information platforms. We should also launch a pilot program of trans-provincial medical expenses checking and reimbursement.

Fifth, to strengthen delicacy management of the NRCMS, promote the reform of payment methods, curb soaring medical expenses and further benefit rural residents. We should regulate the utilization and management of the NRCMS fund to ensure its safety.