Medical expenses have been increasing year after year for five years. The medical insurance fund is facing huge payment pressure.

The "Annual Report on China's Social Insurance Development (2014)" (hereinafter referred to as the "Report") recently released by the Ministry of Human Resources and Social Security shows that in 2014, the medical expenses of employees participating in basic medical insurance were 708.3 billion yuan, an increase of 15.2 percent over the previous year. An increase of 421.8 billion yuan in 2009, an average annual increase of 19.9 percent.

In the context of the rapid growth of medical expenses, medical insurance funds are facing increasing payment pressure, and the balance of multi-provincial co-ordination funds deviates from the red line of "meeting the payment demand for 6 to 9 months.

Drama: The average annual increase in medical costs is nearly 20%.
According to the report, the average cost of ordinary (urgent) visits was 157 yuan, an increase of 6 yuan over the previous year and 44 yuan over 2009, with an average annual increase of 6.8 percent. The average cost of outpatient serious illness was 466 yuan, an increase of 3 yuan over the previous year, an increase of 68 yuan over 2009, an average annual increase of 3.2, and the average cost of hospitalization was 10095 yuan, an increase of 402 yuan over the previous year and an increase of 2465 yuan over 2009.

According to the data released by the collaborative innovation center for health risk early warning and governance led by Fudan University, the annual growth rate of per capita medical expenses in China is expected to be 14.33-18.24 in 2015, significantly higher than the crude growth rate of 8.97 per capita gross domestic product (GDP) in 2013.

Wenxue Guo, a professor at the Chinese Academy of Social Sciences, said, "Price fluctuations are not positively correlated with changes in health costs, and the increase in health spending by any of the three parties, government, society and individuals, exceeds the increase in prices. It can be seen that price fluctuations have a limited impact on health spending and are not the main reason for the rapid growth in health spending." In the past four years, the amount of personal health expenditure has risen sharply, and the huge government investment in medical and health has not reduced the direct burden of individuals.

Relevant experts believe that the per capita medical expenses are increasing too fast, which seriously infringes on the public interest. If the growth rate of per capita income is lower than the growth rate of medical expenses, it means that the burden of seeing a doctor is increasing year by year, leading to poverty due to illness and return to poverty due to illness.

In order to solve this problem, the General Office of the State Council recently issued the "Guiding Opinions on the Pilot Comprehensive Reform of Urban Public Hospitals", which proposes to eliminate the mechanism of supplementing medicine with medicines, promote the separation of medicines in all public hospitals in pilot cities, and take comprehensive measures to cut off hospitals and medical personnel. The chain of interests with medicines, improve the medical expense control system, and strictly control the unreasonable growth of medical expenses. By 2017, overall personal health expenditure as a proportion of total health expenditure will be reduced to less than 30%.

Under pressure: multi-fund balances deviate from the "red line"
High medical expenses not only increase the burden of patients, but also put great pressure on the medical insurance fund.

The report shows that the balance of basic medical insurance for employees continues to increase. In 2014, the total balance of the basic medical insurance fund for employees was 553.7 billion yuan, an increase of 73.1 billion yuan over the previous year, an increase of 15.2 percent, and an increase of 287.6 billion yuan over 2009, with an average annual growth of 15.8 percent.

By contrast, the fund's spending is growing faster. In 2014, the fund expenditure was 669.7 billion yuan (416 billion yuan for overall fund expenditure and 253.7 billion yuan for personal account expenditure), an increase of 86.7 billion yuan over the previous year, an increase of 14.9 percent, 1.1 percentage points higher than the increase in income, and an increase of 406.7 billion yuan over 2009, with an average annual growth rate of 20.6 percent.

Jin Weigang, director of the Institute of Social Security of the Ministry of Human Resources and Social Security, previously stated that from the situation in 2013, there were 225 overall planning areas across the country where the medical insurance funds for urban employees were not able to cover the expenditure, accounting for 32% of the overall planning areas for urban employees in the country. 22 of them have spent all the accumulated balances over the years. In terms of medical insurance for urban residents, in 2013, 108 overall planning areas across the country were unable to cover their income. Medical insurance funds have been overwhelmed, and now the growth rate of various medical insurance fund expenditures has exceeded the growth rate of income.

According to the system design, the balance of the overall medical insurance fund needs to guarantee the payment demand for 6 to 9 months. If it deviates from this "red line", too much or too little will cause problems. The excessive balance of medical insurance fund was a very serious problem before 2009. In 2007, the balance rate of the overall fund was as high as 34.8, with an average balance of 21.5 months, of which Guangdong, with the largest cumulative balance, reached 56.2 months.

According to the preliminary statistics of public data, if calculated according to the ratio of 8:5 of the overall fund to individual account expenditure, in 2014, three provinces and cities may have difficulties in achieving this system design goal. In 2014, Tianjin's fund expenditure was 18.5 billion yuan, but the accumulated balance of the overall fund was only 0.2 billion yuan. Hubei province's fund expenditure is 21.7 billion yuan, and the accumulated balance of the overall fund is 7.9 billion yuan. Guizhou province's fund expenditure is 8.7 billion yuan, and the accumulated balance of the overall fund is only 2.3 billion yuan. In addition, Chongqing's fund expenditure is 156 yuan, and the overall fund balance is 6.9 billion yuan, which is also close to the "red line".

Yu Baorong, a professor at the School of Insurance of the University of International Business and Economics, believes that the medical insurance fund is still in balance at present, but this balance is precipitated in history, and the other is the overall data of the country. Specific to the current period and a certain region, there may not necessarily be a balance.

The sustainability of the Fund will be further affected by changes in the participation demographics. The "China Medical and Health Development Report 2014" previously released by Huazhong University of Science and Technology predicts that in 2017, the basic medical insurance fund for urban employees will not cover the current income, and by 2024, there will be a serious deficit of 735.3 billion yuan in the accumulated fund balance.

Recommendation: Accelerate the development of commercial health insurance.
Experts believe that in order to build a more comprehensive medical security system, in addition to controlling the growth of medical expenses and strengthening the supervision of medical insurance funds, it is also necessary to develop various forms of supplementary medical insurance, among which increased commercial health insurance support is indispensable.

From a worldwide point of view, the responsibility of medical security is shared by the government, enterprises and individuals. At present, my country's commercial health insurance compensation expenditure accounts for 1.3 percent of the total medical and health expenses. The average level in developed countries such as Germany, Canada, and France is above 10%, and the United States is as high as 37%.

In recent years, China's commercial health insurance has developed rapidly. More than 100 insurance companies have carried out commercial health insurance business, with more than 2200 products, covering four categories: disease insurance, medical insurance, nursing insurance and disability income loss insurance, with premium income of 112.35 billion billion yuan. However, due to the lack of close cooperation between insurance companies and hospitals for a long time, insurance companies have no access to information on the incidence of some major diseases, diagnosis and treatment expenses, and the formulation of insurance rates therefore lacks scientific guidance. The profitability of health insurance products is worrying. The market size is still limited.

At the recent press conference of "Report on the Health Status and Medical Benefits of Employees in Chinese Enterprises" held by Ping An of China, Shang Jiaoran, marketing director of Ping An Health Insurance, said that from the analysis of medical expenditure data, the reimbursement rate in the social security catalogue was only 48%, and the remaining 52% of medical expenses had to be borne by employees themselves, all of which made employees face certain pressure on medical expenses.

In fact, while the government continues to increase its support for medical security, it has repeatedly introduced commercial health insurance incentive policies. In October last year, "Several Opinions on Accelerating the Development of Commercial Health Insurance" was issued, which further improved the commercial insurance development system; the "Notice on Carrying out the Pilot Work of Commercial Health Insurance Individual Income Tax Policy" announced in May this year officially opened the health insurance tax The prelude to the preferential policy.
"If we speed up the development of commercial health insurance through certain policies and measures, we will be able to build a medical security system that organically connects basic medical insurance, critical illness insurance, medical assistance, and commercial health insurance." Huang Hong, vice chairman of the CIRC, said that this can effectively increase the supply of medical security, reduce the proportion of personal expenses borne by ordinary people, and effectively reduce the burden of medical expenses on the people.

Industry insiders said that under the promotion of multiple favorable factors, China's commercial health insurance is expected to enter the fast lane. Since 2000, the average annual growth rate of my country's commercial health insurance has been about 25%. In 2014, the market size reached 158.7 billion billion yuan, and the growth rate increased to 41%. It is expected to reach the trillion level within 5 to 10 years.

(Content from China In Vitro Diagnostic Network)