Table 1. Characteristics of the UMIS in 2014.
Content | UEBMI | NRCMS | URBMI |
---|---|---|---|
Year initiated | 1998 | 2003 | 2007 |
Main target population [33] | Urban employees (including private sector employees) | Rural residents (household unit) | Urban informal employees, students, children, elderly people without previous employment |
Population covered | 5.1 million (1998) [34] 283.3 million (2014) |
80 million (2004) 736 million (2014) |
42.9 million (2007) 314.5 million (2014) |
Risk-pooling | At prefecture level | At county level | At prefecture level |
Covered cities | 333 municipalities | 2854 counties | 333 municipalities |
Enrollment feature | Mandatory | Voluntary | Voluntary |
Benefit package | Outpatient and inpatient medical service | Inpatient medical service | Inpatient and catastrophic outpatient medical service |
Source of funding [35] | 8% of annual payroll (6% from employers and 2% from employees) | Government subsidy and individual premium | Government subsidy and individual premium |
Annual premium per capita [36] | 383 RMB (1998) 2841 RMB (2014) |
30 RMB (2003) 411 RMB (2014) |
50 RMB (2007) 409 RMB (2014) |
Annual reimbursement ceiling [33] | Six-times average wage of employee in the city | Six-times disposable income of local residents | Six-times income of local farmers |
Predominate payment method | Global budget, capitation, diagnosis related groups (DRGs) [37] | Global budget, capitation, DRGs | DRGs, bed per day payment, capitation, global budget [38] |
Medical provider | Enrolled hospitals | Enrolled hospitals | Enrolled hospitals |
Note: UEBMI: Urban Employee’s Basic Medical Insurance; NRCMS: New Rural Cooperative Medical scheme; URBMI: Urban Resident Basic Medical Insurance.