The National Healthcare Security Administration (NHSA) has released its annual “Healthcare Security Development Statistical Bulletin” for 2022, revealing an overall break-even performance. By the end of 2022, the number of participants in the national Basic Medical Insurance (BMI) schemes reached 1.345 billion, a decrease of 17.27 million from the previous year, or 1.3% year-on-year (YOY). The coverage rate remained stable at over 95% of the population.
Participant Statistics
A total of 362.42 million people participated in the employee BMI scheme (UEBMI), up 2.3% YOY. Meanwhile, 983.28 million people were covered by urban or rural resident BMI (URBMI) schemes, down 2.5% YOY.
Fund Income and Expenditures
In terms of fund income and expenditures, the BMI funds (including maternity insurance) recorded an income of RMB 3.07 trillion (USD 440 billion) and outgoings of RMB 2.44 trillion (USD 350 billion). The accumulated balance at the end of the year was RMB 4.25 trillion (USD 610 billion). COVID-19 pandemic prevention and controls accounted for RMB 4.3 billion (USD 617.2 million) in spending on nucleic acid detection alone. From 2021 to 2022, over RMB 150 billion (USD 21.5 billion) worth of COVID-19 vaccine expenses were settled.
Inter-Provincial Settlements and Reforms
As of the end of 2022, there were 63,000 inter-provincial hospitalization expense settlements. A total of 89,000 designated medical institutions and 226,000 designated retail pharmacies now offer inter-provincial outpatient expense settlements. Administrations have been ramping up National Reimbursement Drug List (NRDL) negotiations, DRG/DIP payment reforms, and drug and medical consumables volume-based procurement (VBP). In 2022, a total of 2,967 drug varieties were covered by the NRDL.
Payment Controls and Procurement
A total of 206 coordinated regions have realized DRG/DIP treatment and payment controls. Among the actual payment regions, designated medical institutions paying via DRG/DIP stood at 52%, with the coverage of disease types reaching 78%, and the proportion of medical insurance fund expenditure settling via DRG/DIP reaching 77% within the DRG/DIP overall planning area. The central government carried out VBP tenders for both chemical drugs and high-value medical consumables, covering 60 drugs and 5 kinds of orthopedic spinal consumables, with a 48% and 84% average price cut respectively.
Regulatory Supervision
In terms of regulatory supervision, the national medical insurance system inspected a total of 767,000 designated medical institutions in 2022, handled 398,000 illegal institutions, and recovered RMB 18.84 billion (USD 2.7 million) in medical insurance funds. By the end of 2022, the enterprises dishonest rating recorded 197 general dishonest enterprises, 51 medium dishonest enterprises, 21 serious dishonest enterprises, and 4 especially serious dishonest enterprises.
Significance of the Report
The NHSA’s report provides a comprehensive overview of the healthcare insurance landscape in China, highlighting the stability of coverage and ongoing efforts to optimize fund management and regulatory oversight. This data underscores the government’s commitment to improving healthcare accessibility and efficiency for the population.-Fineline Info & Tech
