Lei Xiangping

    lagon235@163.com

    ON July 22, China’s State Council decided that the country will expand its critical illness insurance system to cover more urban and rural residents and that all participants in the country’s basic medical insurance system for urban and rural residents will be protected against critical illnesses by the end of 2015.

    Despite the fact that China’s nationwide critical illness insurance comes much later than some developed countries, it is good news for rural and urban residents who can hardly pay the prohibitive bills that accompany illnesses like toxemia, leukemia and various cancers. The sick will now be able to have their illnesses treated with fewer financial burdens.

    Indeed, such an insurance system will better safeguard low-income patients’ health, protect the income they have earned and saved and build a fair medical care system.

    Critical illness insurance is defined as the second safety net weaved by the government, following the establishment of the first safety net — basic medical insurance for urban and rural residents. With this insurance, when a patient’s medical bills under the basic medical insurance system exceed a certain level, the patient will receive a second reimbursement to relieve his or her burden.

    However, it is a lengthy process before residents can access the insurance. Unlike the millions of workers at State-owned enterprises and public institutions whose critical illness treatments have been covered by a comprehensive health care program with a high reimbursement rate for decades, private or self-employed persons didn’t have access to basic medical insurance until 2002 — except through expensive, private commercial health insurance providers — let alone critical illness insurance.

    It has taken the Chinese Government 13 years to establish nationwide critical illness insurance. I still remember when, 15 years ago, one of my relatives in rural Hunan Province was diagnosed with late-stage liver cancer and hospitalized for four months, which cost her family over 80,000 yuan (US$12,880). Unfortunately, her family could only pay those expenses with borrowed money. It is not hard to imagine how patients suffer when they have a critical illness without any medical insurance.

    Good news rolled in when China managed to establish a nationwide basic medical insurance system in 2012, covering over 90 percent of residents and providing reimbursement of at least 50 percent of their medical expenses. However, basic medical insurance doesn’t work well when it comes to treating critical illnesses because the basic medical insurance sets a reimbursement cap, and major illnesses usually incur high fees that have to be paid by patients.

    Without a critical illness insurance program, a number of tragic cases of people dying because they couldn’t afford their medical treatments have been reported. One man amputated his left leg using a saw because he did not have enough money to get the leg treated. A young mother sold hugs for 10 yuan to strangers in a subway station to collect money to treat her leukemia-stricken daughter. A husband was arrested for forging hospital fee documents to get his wife’s medical bills paid for treating her uremia.

    These examples have propelled the government to introduce the critical illness insurance. Since 2012, the Chinese Government has piloted critical illness insurance by allocating a certain amount of money from the basic medical insurance funding pool and paying insurance companies to cover several critical illnesses. The pilot scheme allows patients to receive reimbursement for around 50 percent of the fees they had to pay out-of-pocket.

    The pilot scheme has begun to bear fruit. As of April, critical illness insurance pilot programs have been established in 31 provinces, municipalities and autonomous regions, covering over 700 million people, and 16 provinces have been able to insure all of their residents. In 2014 alone, the pilot scheme helped 1.15 million patients, with the total fund reserve for the program reaching 9.7 billion yuan.

    Despite the achievements made in the past three years, treating critical illness remains a thorny issue. In nonpilot areas, residents have to shoulder the heavy burden of treating critical illnesses on their own. Besides, there are still some flaws in critical illness insurance system: the reimbursement rate isn’t high enough, not all critical illnesses are covered by the insurance and some fund reserves are already running dry.

    This July, the State Council pledged to increase the reimbursement rate gradually and urge insurance companies to provide better services and favorable reimbursement terms. Also, some local governments have set up medical rescue funds and some charity institutions have introduced special programs catering to critical illness treatment — both serving as important supplements to critical illness insurance. These efforts altogether benefit patients by offering them multiple options.

    China has a huge number of people hospitalized every year and providing affordable medical services to those suffering from critical illnesses remains a challenge to the government. The government must hammer out the critical illness insurance before it is too late. A good start has been made, but more needs to be done.

    (The author is an editor with the News Desk at China Radio International.)