The reform of China's medical insurance system faces many heavy tasks. In
future, the state will further expand the coverage of medical insurance to
steadily include eligible people in all kinds of employment in urban areas in
the basic medical insurance scheme; strengthen and improve medical insurance
management and services; curb the irrational increase of medical expenses, and
provide better services for the insured; establish and improve a multi-level
medical security system, gradually lessen personal burden on the insured, and
realize the stable operation and sustainable development of the medical
insurance system.
IV. Insurance for Work-related Injuries
The Chinese Government has made great efforts to establish an insurance
system for work-related injuries that includes work-related injury prevention,
compensation and recovery. After January 2004, when the "Regulations on
Insurance for Work-related Injuries" went into effect, the coverage of such
insurance has expanded rapidly. By the end of June 2004, as many as 49.96
million employees had underwritten this insurance scheme.
Establishing a Social Pool System for Insurance
Funds for Work-related Injuries
The state stipulates that all enterprises and all individual businesses
engaged in industry and commerce with employees must participate in work-related
injury insurance, and pay insurance premiums for all their employees, permanent
as well as temporary. The individual employees do not pay such premiums. The
work-related injury insurance scheme adopts a social pool fund program with a
balance of revenue and expenditure, and collection determined by expenditure.
The social pool funds are established by cities at the prefecture level or
above. The government determines the differential premium rates according to the
degree of risk of work-related injuries involved in different sectors, and sets
several premium rates within each sector according to the insurance payments and
occurrence rates of such injuries.
Defining the Social Security Benefits
The work-related injury insurance scheme adopts the principle of "no-fault
compensation." The benefit items mainly include medical expenditures for
work-related injuries; injury and disability subsidy, allowance and nursing fee
according to the degree of loss of the ability to work; funeral subsidy, pension
for the keep of family members and a lump-sum death subsidy payment, all of
which go to the directly-related family members of the deceased worker in the
case of death resulting from a work-related accident. The main qualifying
condition for insurance payment is that the employee has been injured as a
result of a work-related accident or has contracted an occupational disease
during his or her working hours and within his or her workplace.
Exercising a Labor Ability Assessment
System
The state has uniformly formulated and promulgated a national standard for
assessment of the degree of a work-related injury and the degree of a disability
caused by an occupational disease, whereby to assess the labor ability of an
employee suffering from disability and whose labor ability has been affected due
to a work-related injury, notwithstanding its being in a relatively stable
condition after treatment. The labor ability assessment includes rating of the
degree of physical impediment for labor and the degree of impairment to
self-care ability. A labor ability assessment committee, consisting of
representatives from relevant departments of the government, trade unions and
employing units, is formed in each provincial-level city and city divided into
districts to be in charge of the assessment of labor ability of injured and
maimed employees. Application for labor ability assessment can be submitted by
the employing unit, the employee suffering from the injury, or his or her
directly-related family members, to the local committee. Having received the
application, the committee will randomly choose members from its reserve of
medical and health experts to conduct the assessment, and give its assessment
conclusion based on the experts' opinions.
