January 2020

888棋牌在线讨论了2020年第一期新闻通讯的内容, 我的同事自然会问我, 作为公司的中国专家, to write something about “what’s going on in China that our MedTech customers would be interested in”. 我的简短回答是:“降价”和“drg”。. 我在之前的时事通讯中提到过, which will continue to haunt the industry players and shape the industry landscape as the Chinese government’s reform advances.

但在我报告这些方面的进展之前, I’ve noticed an official statistical report of the 2018 national social health insurance fund, which provides high-level data for an outsider to try to grasp the essential characteristics of China’s healthcare funding and delivery system and understand the challenges an industry player as well as the Chinese government payer are facing with in terms of the funding constraints.


中国政府主导的, 国家社会888棋牌在线计划(称为基本大发888在线娱乐保险), BMI)大约在20年前的90年代末被引入.

Understandably the employee scheme has always been the main cornerstone of the BMI and the most well-funded scheme given that the contributions are coming from both the individuals and their employers. But that only covers less than 1/3 of the total population in China as there is a huge rural population who do not have any formal employment arrangements for various reasons, 再加上那些失业的城市居民家属等.

类似于奥巴马医改, 大发888在线娱乐改革的目标之一, 从2009年开始在中国, 是为了确保每个中国人都能获得负担得起的大发888在线娱乐. The focus, since then, has been switched to look after the previously ignored or poorly-insured populations such as the farmers as the government is trying to tackle the inequality issue in health care.

从2016年开始, the government has taken a more aggressive approach to integrate the rural scheme with the city resident’s scheme in the context of eliminating the inequalities between urban and rural residents. The structural change has resulted in a sharp increase in the number of covered lives whereas the BMI funding source itself has remained the same.

It is now not difficult to understand why the Chinese government is not really interested in the industry’s lobbying messages to try to improve coverage and be friendly with newer but often more expensive medical technologies when they are struggling with allocating the same amount of health care budget with 1.30亿人,而不是3亿人.


外卖1:尽管中国似乎正在实现其全民覆盖的目标, the coverage levels are still different between the Employee Scheme and the other two schemes

表一列出三个公众计划的保障生命及基金结余. 你可以清楚地看到,雇员计划比其他两项计划的资金要好, 特别是如果试图计算和比较人均水平上的基金余额.


职工基本大发888在线娱乐保险 (以下简称 EBMI) is mandatory health insurance for urban employees of state-owned or private enterprises, 由雇主和雇员出资.

居民基本大发888在线娱乐保险 (RBMI)是为未纳入该计划的居民而设的888棋牌在线保险计划,例如.g. 老人、失业者、儿童、学生、残疾人等. 在2016年之前,只有城市居民被纳入该计划,即URBMI.

新型农村合作大发888在线娱乐制度 (NRCMS是为农村居民制定的大发888在线娱乐计划. 资金由个人自愿捐款和政府补贴组成. 2016年起,新农合与城市大发888在线娱乐中心合并.

Total medical insurance claims and claims per insured person are increasing steadily over the years, resulting in 6.2018年EBMI计划每名被保险人平均2宗申索(图1). However, the number is much lower for the resident scheme as the average number of claims is only 1.RBMI中每个被保险人7个.


结论2:每次住院治疗的平均花费是11,2018年EBMI参保人群为181元,6元,RBMI人群为577元. 其中28%和43%是患者的自付费用.

The report also provides valuable national statistics in terms of the average BMI spending per hospital admission as well as patient’s OOP spending.

虽然保险较好的人口有更多的门诊就诊, 如图2所示,入学率在EBMI(18)之间是相当的.3%) and RMBI (15.2%). 然而,每一次EBMI住院患者的平均住院护理支出, 11,181元几乎是RBMI的两倍,平均花费为6元,577 yuan.

住院治疗费用和住院治疗百分比ebmi rbmi索赔

Out of that 11,181 and 6,平均住院费用577元, patient’s out-of-pocket costs account for 28% and 43% respectively for people covered by EBMI and RBMI.

Takeaway 3: Despite the government’s efforts to promote a tiered care delivery system in China, 集中在三级医院提供护理的情况有所增加.

It is also interesting to observe that despite the government’s efforts to establish a tiered care delivery system in China, patients still prefer to go to Tier III hospitals (highest hospital ranking) to seek medical care (Figure 4). The BMI statistics over the period of 2012 and 2018 revealed that the percentage of inpatient admissions in Tier III hospitals has been increasing steadily and in contrast the percentages of patients going to Tier I and II hospitals are fairly flat or even decreasing over the same period of time.


Takeaway 4: Diagnostics and treatments account for 51% of the inpatient care spending and medicine, 35%.

Expenditure of outpatient care accounts for about 40% and inpatient care about 60% of overall expenditure of EBMI in 2018.

Diagnostics and treatments accounted for half of the inpatient care spending and medicine, 35%.



波士顿大发888在线娱乐的客户, 尤其是那些在中国有业务的公司, typically target and service the more affluent populations covered by the Employee Scheme. The national health insurance data only confirms the importance of this target population as well as the importance of Tier III hospitals in care delivery.

The analytical exercise is also intended to help our clients understand the practical challenges from the payer’s perspective and prepare our clients for the ongoing attempts and activities from the Chinese governments at all levels to cut prices.

作者:BHA亚太区副总裁兼常务董事Betty Su.

波士顿大发888在线娱乐对中国不断变化的大发888在线娱乐格局有着深刻的理解. Our in-market experts closely monitor the policy and market trends on the strategic markets like China to help clients stay ahead of industry trends. Please contact us if your team needs help developing strategies and action plans to identify opportunities or tackle the issues.