The Evolution of HTA in Emerging Markets Health-Care ... - TREE

OHE Consulting Report for PhRMA
5 January 2011
A.2.3 The initiation of health coverage reform in 2003
Major health care reform began in 2003 to rebuild the failing CMS and LIS schemes. China now has
three major healthcare insurance schemes (Liu et al., 2009):
The New Rural Cooperative Medical Scheme (NRCMS, also known as the NCMS). NRCMS is a
subsidized health insurance scheme for rural populations (offering benefits covering
primarily inpatient care and major outpatient expenses) with voluntary enrolment on a
family basis. The intention is to move the benefit package away from insurance for
expensive hospital care to one risk pool for inpatient and outpatient services; encouraging
coverage for treatments for chronic conditions. The scheme involves a subsidy of RMB 80
($11.40) (made up of 50% each coming from central and local governments) towards an
annual premium of RMB 100 ($14.30) with individuals’ contribution set at RMB20 ($2.90).
Patient co-­‐payment is in the region of 50-­‐60%. There is however a separate Medical
Assistance Safety Net, which helps the poor pay their NRCMS premiums and reduces their
co-­‐payment rates.
The Urban Employment Basic Medical Insurance (UEBMI) is a mandatory insurance scheme
for formal sector workers in urban areas covering 200 million urban employed people. The
UEBMI is, in Chen, Banta and Tang (2009), referred to as National Urban Social Medical
Insurance Scheme for Employees and Retirees (USMISER). Financing of the UEBMI comes
from 8% payroll tax, 6% from employers and 2% from employees for coverage for essential
healthcare.
The Urban Resident Basic Medical Insurance (URBMI). The URBMI is a voluntary subsidized
insurance scheme for urban residents not in formal employment including children and
students. In Chen, Banta and Tang (2009), this is referred to as the national Urban Resident
Medical Insurance Scheme (URMIS).
The role of private insurance is small and restricted to offering complementary or
supplementary health insurance benefits (to that offered by the three other schemes) (Liu et
al, 2009).
In addition there is a Government Insurance System for government employees, but there is an
expectation that it will be integrated with the UEBMI.
A2.4 Remaining Challenges and Other aspects of reform
The extent of integration of the health insurance schemes
The current insurance platforms aim to cover different people at different locations, which currently
still leaves a large number of people out of the insurance pool. The Ministry of Human Resources
and Social Security (MoHRSS) is responsible for the UEBMI and the URBMI. The Ministry of Health
(MoH) is responsible for the NRCMS. The Provinces also play an important role in the administration
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