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Table 1 Insurance Policy in Study Cities(2008)

From: Financial burden of healthcare for cancer patients with social medical insurance: a multi-centered study in urban China

Shanghai [21] Beijing [22] Fuzhou [23] Chongqing [24]
Financing contribution: Format: basic insurance + supplementary insurance (as proportion of annual income)
12% + 2% 11% + $5 &1% 10% 10% + $4 &1%
Personal Medical Account
Op visit, deductible and copayment for hospital admission and retail pharmacies
OP visit coverage (after personal medical account): Format: deductible + reimbursement rate (for primary/secondary/tertiary hospital)
Employee: $216 + 70%/60%/50% Retiree: Retired before 2001: $43 + 90%/85%/80% Retired after 2001:$101 + 55%–85%/50%–80%/45%–75% (vary to age) Employee: $259 + 70%/50%/50% Retiree: $187CNY + 70–80%(vary to age) [25] No coverage No coverage
Hospital admission coverage: Format: deductible + reimbursement rate (for primary/secondary/tertiary hospital)
Employee: $216 + 85% Retiree benefit: Retirement before 2001: $101 + 92% Retired after 2001: $173 + 92% Deductible: 10% of average wage of urban employees from previous year; 5% from the second admission on; Reimbursement: From deductible to $4323, 90%/ 87%/85%; From $4323–$5764, 95%, 92%, and 90%; From $5764 to maximal payment limit, 97%/97%/95% Employee: $86/$86/$115 + 85–92% Retiree: $86/$86/$115 + 90%–95% aDeductible reduce $29 per hospital admission for multiple admissions Deductible: 5%/8%/11% of average wage of urban employees from previous year; Reimbursement: From deductible to $720, 70–85%(vary to age); From $720–$1441, 75–90% (vary to age); From $1441–$4611, 80–95% bDeductible decrease 1% per hospital admission for multiple admissions
Special management for malignant cancers (patients side)
85% reimbursement for OP treatment of chemotherapy, radiotherapy, isotope therapy, interventional anti-cancer treatment, TCM anti-cancer treatment and necessary relevant examinations [26] For OP treatment of radiotherapy and chemotherapy for malignant cancer, all related OP visits in 3 months were regarded as one hospital admission and has the same reimbursement policy For chemotherapy and radiotherapy for malignant cancers, $144 deductible +90%/85%/85% (employee) or 94%/90%/90% (retiree) [27] Same deductible as hospital admission + 90% reimbursement for radiotherapy, chemotherapy, and pain management [28]
Maximal payment limit
$10,086 (including OP visit and hospital admission) 400% average wage of urban employees from previous year (including hospital admission and special OP visit) $6484 (including hospital admission and special OP visit) $4661 (including hospital admission and special OP visit)
Supplementary insurance
Reimbursement rate 80% after maximal payment limit Reimbursement rate 70% after maximal payment limit, with the annual maximal of $14,409 ($2882 for OP visit) None Reimbursement rate 100% after maximal payment limit, with the annual maximal of $57,637 [29]
Provider payment systema
Global budget: every year, the insurance agency will negotiate with each hospital about its certain budget on the basis of its total expenditure in the past 3 years and the expanding trend of its services. If the actual expenditure was less than 80% of the budget, hospital will get the actual expenditure from the insurance fund; if the actual expenditure was around 80–100% of the budget, hospital will get the budget and the gap between the budget and the actual expense can be invested on the hospital (any forms of bonus for hospital employees are forbidden); if the actual expenditure was around 100–120% of the budget, the hospital can get the budget and part of the expense over the budget (the proportion depends on the operation of insurance of that year) Service charge (case payment was explored in Beijing from 2009) Certain package for each episode of hospital admission (also apply to OP visit of cancer patients): $893 per hospital admission for general disease. $2882 per hospital admission for 16 kinds of severe diseases (cancer included). For expense less than $2882, the hospital will get the actual expense Certain package for each episode of hospital admission (also apply to OP visit of cancer patients): $836/$634 ~ $648/$432/$288 per hospital admission for teaching/tertiary/secondary/primary hospital; if the actual expense was around 80–100% of the contracted quota, the hospital will get the contracted quota
  1. aSpecific policy documents were not available, and the information was summarized from qualitative interviews with officers in insurance agencies