Medical insurance reimbursement rate for Gansu urban residents rises to 70 percent

A notice to further promote medical and health care system reform was issued by the Gansu provincial government on Sept 25.

In accordance with the notice, medical insurance and government subsidies for Gansu urban residents in the New Rural Cooperative Medical Scheme (NRCMS) rose to 280 yuan ($45.75) per person per year. Hospitalization cost reimbursement rates for urban residents’ medical care and the NRCMS are now over 70 percent and around 75 percent, respectively.

The participation rates of the three basic medical insurances – workers’ basic medical insurance, urban residents’ basic medical insurance and new rural cooperative medical insurance – are above 97 percent. Urban residents’ medical insurance and government subsidies for the NRCMS rose with the increase of urban residents’ payment capacity.

The notice encourages developing financing mechanisms based on economic development. The payment proportion of medical insurance for urban residents and the hospitalization costs of the NRCMS increased to above 70 percent and about 75 percent, respectively. This further narrows the gap between the costs and the proportion of payment of actual hospitalization costs. Outpatient medical treatment also increased accordingly.

The notice attaches importance to medical payment reform, including capitation payment and payment in accordance with disease types. Efforts were made to establish negotiation mechanisms between medical institutions, pharmaceutical suppliers and medical insurance agencies, as well as payment mechanisms for purchasing services.

Sound evaluation and quality supervision systems must be established to avoid unpractical quota allocations and unsatisfactory medical service quality. The medical and health care system will expand its supervision not only over medical institutions and their services but also to medical personnel.

The overall planning of workers’ medical insurance and urban residents’ medical insurance will be made at the municipal level. The regions with good economic conditions are encouraged to upgrade the NRCMS coordination level. Medical insurance institutions’ management service capabilities will also be improved.

In accordance with practical experiences, Gansu will promote a settlement service for medical treatment received in a different place and will implement a direct settlement for remote medical treatment within Gansu gradually. It will also develop an instant settlement mechanism for treatment out Gansu.

Gansu stresses the construction of grassroots medical institutions and their ability to provide traditional Chinese medical services. Traditional Chinese medical services are available in 80 percent of community medical service institutions, township hospitals and village clinics. A pilot township hospital dormitory has also been launched. A program to provide free training for directed medical students in rural areas in central and western regions shall continue.

The general medical fees of village clinics will be included in rural doctor incomes, which will also serve as a compensative function for the NRCMS. A long-term subsidy mechanism for basic medicine services in village clinics shall be established. Apart from subsidies from the central government, the provincial government shall subsidize rural doctors 200 yuan ($32.68) per month. The local government will also provide subsidies for them.

Based on the notice, the treatment capacity of serious diseases will be stressed. The patient rates transferred from county-level hospitals to those of upper levels will be limited within 10 percent, with an aim that most serious diseases be diagnosed and treated in county-level hospitals.

In regard to medical personnel, Gansu improves long-term cooperation and support mechanisms between urban hospitals and county-level hospitals. Meanwhile, the training program for elite doctors in county-level hospitals will be continued.

The cancellation of the mechanism to subsidize medical service with overly expensive drug prescriptions is a key step in the comprehensive reform of institutional mechanisms. Gansu is actively controlling unreasonable rises in medicine prices. It attaches importance to promoting the primary diagnosis responsibility system, improving grading diagnosis and the two-way referral system.