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Table 1 Policy design of the MFA program and SHI programs in China

From: Is the medical financial assistance program an effective supplement to social health insurance for low-income households in China? A cross-sectional study

 

Medical Financial Assistance (MFA)

Social Health Insurance (SHI)

Policy implementation

2003: The Ministry of Civil Affairs piloted the MFA in a few rural areas;

2005: The Ministry of Civil Affairs piloted the MFA in a few urban areas;

2009: The MFA reached universal coverage across the whole country;

2013: The Ministry of Finance and the Ministry of Civil Affairs required localities to coordinate the management of SHI programs and the MFA, aiming to provide one-time reimbursement to target households;

2014: The State Council enacted the Draft Decree on Social Assistance, legitimizing the MFA as an indispensable part of social assistance programs;

2015: The State Council ruled that the MFA gives priority to households with serious illnesses.

1998: The State Council established the Urban Employee Basic Medical Insurance (UEBMI);

2003: The Ministry of Health, the Ministry of Finance, and the Ministry of Agriculture established the New Cooperative Medical Scheme (NCMS);

2007: The State Council established the Urban Resident Basic Medical Insurance (URBMI);

2009: The Communist Party of China Central Committee and the State Council launched a new health care reform;

2010: The three SHI programs reached universal coverage across the whole country.

2016: The State Council decided to integrate the URBMI with the NCMS.

Targets

(1) Households enrolling in the Minimum Living Standard Scheme (MLSS). The MLSS is a national social assistance program and targets the poorest households where monthly or yearly income is lower than a certain criterion. Unlike the national unified poverty line [2300 Chinese Yuan (USD372) in 2011 and 3000 Yuan (USD488) in 2016] that was regulated by the State Council Leading Group Office of Poverty Alleviation and Development to facilitate county-based poverty alleviation, the MLSS, run by the Ministry of Civil Affairs, is a household-based cash aid program. Its criterion of eligibility is county-specific in most areas and province-specific in some others. In 2016, the criterion in Shanghai was a monthly income per person of 880 Yuan (USD143) for a household, the highest in any province. An MLSS applicant must be reviewed through a complicated means-test of his/her household’s monetary income, basic living needs, and other household characteristics such as labor capacity and severe illnesses. The difference between the estimated income of an MLSS household and the local MLSS criterion is paid to the household.

(2) Extremely poor residents (EPR, including: “Sanwu,” urban residents with no income, labor capacity, or caregivers; “Wubao,” rural residents with no income, labor capacity, or caregivers; “Tekun,” households defined as extremely poor by the Draft Decree on Social Assistance).

(3) Low-income families not enrolled in the MLSS (LIF, identified by local government; the criterion is usually a monthly family income of between 100% and 120–150% of the local MLSS line).

(4) Persons who are identified by county government.

(1) The UEBMI provided mandatory coverage to urban employees.

(2) The URBMI provided voluntary coverage to urban residents without formal employment.

(3) The NCMS provided voluntary coverage to rural residents.

Benefit package

Dual benefit package:

(1) Subvention for SHI enrollment. Target households are subsidized for their enrollment in SHI programs.

(2) Cash aid. Members of target households can apply for MFA cash aid from the county Bureau of Civil Affairs if their OPE exceeds the thresholds of the MFA. If they are enrolled in a SHI scheme, MFA cash aid is provided as a proportion of their OPE; if not, the MFA cash subsidy is provided as a proportion of their total medical expenditure.

Covers both outpatient and inpatient services and provides reimbursement to patients immediately or afterwards.

Funding sources

Raised from (1) government budget, (2) lottery welfare fund, and (3) society donations;

County government normally sets up a special and independent MFA account within the SHI system, manages all funds uniformly, and takes full responsibility for its activities.

Raised by a special SHI agency or taxation agencies by collecting premiums;

Premium for the UEBMI is contributed by individual employees and employers;

Premium for the URBMI and the NCMS is contributed by individual residents and the government.

  1. Sources: See references [34], [35,36,37,38,39,40,41]