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].

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]

Core Insights - The report by the International Labour Organization highlights China's significant achievements in expanding universal health coverage, providing valuable experiences for other countries pursuing similar goals [1][2] Group 1: Achievements in Health Coverage - China has established a multi-tiered medical insurance system, expanding coverage from urban workers to rural residents and urban residents, with increasing levels of protection [1] - The basic medical insurance, serious illness insurance, and medical assistance form a three-tiered system to alleviate financial burdens, complemented by commercial health insurance and charitable assistance [1] Group 2: Health Indicators - In 2023, China's average life expectancy increased to 78.6 years, maternal mortality rate decreased to 15.1 per 100,000, and infant mortality rate fell to 4.5 per thousand, placing major health indicators among those of middle to high-income countries [2] Group 3: Challenges Ahead - Despite progress, China's healthcare system faces challenges such as incomplete coverage, quality of insurance, rapid growth in medical costs, and increasing pressure on insurance funds [2] - Future efforts should focus on accurately identifying uninsured individuals, improving insurance quality, establishing a fair and unified benefits system, and developing a stable and sustainable funding mechanism [2]