Health ministry to expand insurance to include 20 serious illnesses

Ministry to expand basic coverage in rural areas from just two to 20 afflictions - like lung cancer

PUBLISHED : Tuesday, 22 January, 2013, 12:00am
UPDATED : Tuesday, 22 January, 2013, 4:04am

The Ministry of Health has pledged to lower medical bills for rural patients suffering from any of 20 serious diseases and says they might pay as little as 10 per cent of the bill. But social insurance experts are sceptical about the sustainability of the scheme.

The focus of medical insurance in rural areas this year will be shifted to 20 serious diseases, including lung cancer, gastric cancer, rectal cancer and haemophilia.

Rural patients with any of those diseases will have at least 70 per cent of the inpatient bills - and in some cases 90 per cent - reimbursed, The Beijing News reported, citing an unidentified ministry official.

More than 812 million rural residents, or 98 per cent of the mainland's rural population, have been insured under the New Rural Co-operative Medical Scheme, a form of basic medical insurance designed for rural residents as part of the country's ongoing health care reform, with the government paying the lion's share of the premium and residents contributing less.

Even though the scheme has covered most of the rural population since its establishment in 2003, it has been widely criticised for its limited coverage - only inpatient service in a lot of cases - and low reimbursement levels. Serious diseases are not always covered.

Congenital heart disease and leukaemia were only included in a pilot basic medical insurance scheme three years ago. Last year, eight types of serious diseases were included, and 12 types of serious illnesses, such as lung cancer, would be included in the basic coverage this year.

Last year the average premium for each farmer was 300 yuan (HK$370) and the reimbursement level for inpatient medical bills was 50 per cent. This year, the average premium will be increased by 40 yuan and the reimbursement level will be 55 per cent.

The ministry issued a directive in November demanding that grass-roots health authorities in at least one-third of rural areas experiment with expanding serious disease coverage from just two - leukaemia and congenital heart disease - to 20 conditions.

The directive said the pilot programme should reimburse at least 70 per cent of medical bills covered by insurance. However, patients usually end up paying a bigger proportion of their medical bills because many things are not covered by insurance.

For the part not to be reimbursed by basic medical insurance, a new public insurance scheme will pay at least half of the remaining bill. The new scheme was announced in September by the National Development and Reform Commission and five other government agencies, promising greater protection for people in rural areas and unemployed urbanites.

Poor farmers can also apply for a 15 per cent medical assistance allowance from civil affairs authorities that, when added to the other schemes, would see 90 per cent of the total medical bill reimbursed.

Professor Zhu Junsheng , from the Capital University of Economics and Business, said the pledge's implementation would depend on the success of public insurance for serious diseases.

It is supposed to be purchased from commercial insurers, tapping unused funds from basic medical insurance, but how the scheme will perform is not yet clear.

Zhu's research showed the insurance was not well received because the authorities responsible for basic medical insurance, the Ministry of Health for rural residents and the Labour Ministry for unemployed urban residents, were reluctant to cede power to commercial insurance companies.

The guidelines for public insurance for serious illness allow commercial insurance companies to make only meagre profit, and Zhu said they would only take part in it to build brands, maintain government relationships or develop potential clients. They would pull out if there was no benefit whatsoever.

"When they are gone, the game would be over," Zhu said.

Professor Chu Fuling , a social security specialist at Central University of Finance and Economics, said the expanded coverage was better than nothing - but still was not the best solution.

"The current design is basic insurance that always come with a cap [on funding]," Chu said.

He proposed a new kind of co-operative fund, paid by rural residents voluntarily, that would save rural families from "catastrophic spending" once a family member falls seriously ill. The fund, Chu said, would be non-profit and would save administrative costs by buying insurance from commercial insurance companies.