2025.05. 22 本文字数：2402，阅读时长大约4分钟 作者 | 第一财 经 郭晋晖 过去20多年间，我国医疗保险参保人数从制度起始的不到2000万增加到13.3亿，基本实现医保全民覆 盖，用占GDP2%左右的医保筹资撑起了全世界约六分之一人口的求医问药。 国际劳工组织近日发布的《迈向全民医疗保障的中国经验》（下称"报告"）称，近年来中国致力于建立 健全多层次的医疗保障制度体系。中国基本医疗保障覆盖面实现了从城镇职工扩展到农村居民、再到城 镇居民，覆盖面从小到大，保障水平从低到高的转变。 报告同时也显示，发展中的中国医保依然面临着参保未完全覆盖、参保质量有待提升等问题。中国基本 医疗保险参保率维持在95%左右，5%左右的未参保人口成为中国真正实现全民医保的"最后一公里"。 1998年12月《国务院关于建立城镇职工基本医疗保险制度的决定》出台，国务院正式建立起职工医 保，确定了"属地"原则，2002年覆盖了中国城镇企业和机关事业单位工作人员。 随着新农合和城镇居民医保制度的建立，2007年，中国基本医保参保人数（包括新农合）迅速增加至 9.49亿人，参保率快速提高至71.83%。从参保人数和参保率变化可 ...

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]