医保参保人数达13.3亿！成世界最大基本医疗保障体系

Core Viewpoint - Over the past 20 years, China's medical insurance coverage has expanded significantly, achieving near-universal coverage with 1.33 billion insured individuals, representing approximately 94.6% of the population, supported by a funding model that allocates about 2% of GDP to healthcare [1][3][5]. Group 1: Coverage Expansion - The number of individuals covered by basic medical insurance in China increased from 18.79 million in 1998 to 1.334 billion by the end of 2023, marking a coverage rate increase from 1.51% to 94.6% [3][5]. - The establishment of the Urban Employee Basic Medical Insurance in 1998 and subsequent systems like the New Rural Cooperative Medical Scheme and Urban Resident Medical Insurance significantly contributed to this expansion [3][5]. - Since 2011, the insurance coverage rate has stabilized around 95%, but progress in covering the remaining 5% of the population has been slow [5][6]. Group 2: Quality of Coverage - The current insurance structure exhibits a "dual structure," with over 70% of insured individuals under the resident insurance scheme, which is nearly three times the number of those under the employee insurance scheme [5][6]. - Approximately 200 million urban workers remain uninsured, primarily due to the financial burden of voluntary contributions and dual payment responsibilities [5][6]. - There is a notable challenge in ensuring that healthy individuals and migrant workers participate in the insurance system, which poses sustainability risks [5][6]. Group 3: Financial Aspects - In 2023, the average funding for employee medical insurance was 6,182 yuan, while the resident insurance averaged 1,098 yuan, with total medical insurance fund income reaching 3.35 trillion yuan [8][9]. - The establishment of a unified management system for various medical insurance schemes has enhanced the pooling capacity of funds [8]. - The proportion of personal cash health expenditure as part of total health expenses decreased from 55.87% in 2003 to 27.33% in 2023, indicating a reduction in individual financial burdens due to the insurance system [9]. Group 4: Challenges and Recommendations - The aging population and rising healthcare costs are increasing pressure on the medical insurance fund, with the ratio of active workers to retirees in employee insurance dropping from 4.09 in 1998 to 2.71 in 2023 [10]. - Retired individuals account for about 25% of the insured but generate nearly 60% of total medical expenses, creating a significant financial strain on the system [10]. - Recommendations include exploring dynamic funding mechanisms linked to economic development and household income, as well as expanding funding sources through commercial health insurance and taxation on harmful products [10][11].