China’s Reimbursement Policy for Long-term Care Brings New Medical Opportunities

Written by the director of a reimbursement department, at a tier 3 hospital in Beijing.

Since 2000, China has become an aging society, and the unmet needs of long-term nursing and medical services have become an urgent social problem for China’s socio-economic growth.

As of 2015, the number of China’s citizens aged over 65 years reached 144 million, and the current number of disabled elderly in need of long-term nursing and medical services, according to conservative estimates, exceeds 40 million. However, because of the previous one-child policy, small families make it impossible for young Chinese to take full responsibility for the long-term care of all their parents and grandparents.

As a result, many elderly people choose long-term hospital care in order to spend their remaining days in comfort, leading to a huge waste of medical resources in China. To tackle this tough problem, the Chinese government has recently launched a pilot project on long-term medical reimbursement for its citizens.

In June 2016, the Office of the Chinese Ministry of Human Resources and Social Security issued The Guidance on the Long-term Nursing Reimbursement Pilot Policy. Within 1-2 years, the policy aims to provide long-term disabled people with financial support – or service guarantee – for their basic medical care. According to the policy, there are all together 15 pilot cities selected for the first trial. The policy stipulates that the government should raise money by optimizing the structure of workers’ medical care accounts, transferring the balance of workers’ medical care fund, and regulating the rate of medical reimbursement; gradually establishing a multi-channel and dynamic financing mechanism. For those long-term care costs, which cover related provisions, the reimbursement fund will cover 70% of the total payment.

In the foreseeable future, the Chinese government is committed to provide full medical reimbursement coverage for all Chinese citizens. To achieve this goal, the Chinese government will improve its management mechanism and involve other social organizations, such as commercial insurance institutions, to handle these services. Simultaneously, the Chinese government will also establish a multi-level targeted social security system. While some high-end needs may be supplemented by commercial insurance, the government will be responsible for the remaining parts. In the initial stage of the policy implementation, the medical reimbursement fund will bear most of the financing obligations, without increasing the burden on businesses or individuals. In the long term, individuals and businesses should bear appropriate portions of the payment in order to ease the financial pressure off the government.

In the next three to five years, the policy might reveal a series of gaps in coverage and other challenges facing Chinese society, but also create great opportunities for relevant enterprises and individuals.

First of all, in order for China’s nursing and medical care policy to be sound, the Chinese community is calling for a new set of institutional management approaches, quality evaluation systems, and medical service standards for this field.

Secondly, China’s construction of nursing and medical delivery system is heavily lagging behind national demand. Accordingly, it is in urgent need of professional nursing facilities and medical institutions, consumables, medical equipment and other services.

Finally, professional nursing and medical staff are scarce in China. It is estimated that currently the Chinese society needs nearly 10 million professionals for long-term nursing and medical care; however, the existing number is far fewer, of which less than 10% are certified professionals. Challenging the situation even more, is that the vast majority of elderly-homecare workers are between 40-50 years’ old, most of their qualifications are junior high school level or lower, and most come from rural areas.

2016 witnessed a significant milestone where the Chinese government included long-term nursing and medical services into its health reimbursement policy. We hope that more and more entities, both in China and from abroad, will seize the opportunity and meet the challenge, working together with the Chinese government to improve the care system for the large population of 1.3 billion.

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