参保人数从1800万到13.3亿，全民医保如何补上最后一块“拼图”|晋观医养

Core Insights - China's basic medical insurance system has achieved significant coverage, with 1.33 billion people insured, representing 94.6% of the total population, making it the largest basic medical security system globally [2][5] - The insurance structure exhibits a "dual structure," with over 70% of participants in resident insurance, highlighting the need for improved insurance quality [5][6] - The report indicates that approximately 2 billion urban workers remain uninsured under the employee insurance scheme, suggesting a gap in coverage [5][6] Coverage and Participation - The basic medical insurance participation rate has increased from 1.51% in 1998 to around 95% since 2011, with significant contributions from the establishment of new rural cooperative medical insurance and urban resident insurance [2][5] - The report notes that the participation rate has stabilized at around 95%, with slow progress in covering the remaining 5% of the population [5][6] Financial Aspects - In 2023, the average funding for employee insurance was 6,182 yuan, while for resident insurance, it was 1,098 yuan, indicating a disparity in funding levels [7] - The total income of the basic medical insurance fund reached 3.35 trillion yuan in 2023, with employee insurance contributing 2.29 trillion yuan and resident insurance 1.06 trillion yuan [7] Impact on Healthcare Costs - The establishment of the basic medical insurance system has significantly reduced personal medical expenses, with personal cash health expenditure as a percentage of total health expenditure decreasing from 55.87% in 2003 to 27.33% in 2023 [10] - The number of medical service utilizations has increased dramatically, with outpatient visits rising from 2.145 billion in 2002 to 9.55 billion in 2023 [10] Recommendations for Improvement - The report suggests focusing on flexible employment and new business model workers to enhance participation in employee insurance, advocating for a shift from "local insurance" to "residence-based insurance" [6][11] - It recommends exploring a dynamic funding mechanism linked to socio-economic development and increasing funding sources, including taxes on unhealthy products to support basic medical insurance [11]