CHINA RURAL SCHEMES

 » The Xiaoshan NRCMI scheme

No. of communes: 26 Land area: 1,420 km. sq. Total population: 1,166,657 Rural population: 852,742 GDP: 50B yuans GDP per capita: 43,058 County govt revenue: 2.3B yuans

Substantial elements of the Xiaoshan NRCMI scheme

Xiaoshan is among the first group of counties/districts selected for the pilot exercise. After a short preparatory period during which a number of detailed documents, including the Regulation on the Xiaohan NRCMI scheme, were issued in line with the general guidance laid down by superior governments, the scheme was then launched on 1 October 2003 and has been implemented since. Some of its substantial elements are illustrated below.

Target population

All residents, either rural or urban, can participate as long as they are not yet covered by an urban health insurance scheme. Contribution payment made on a family basis is the condition for being actually insured under this scheme, except for three specified groups, whose due contributions are paid by the local governments.

Financing

As Xiaoshan is rich, the scheme receives no subsidy beyond the district and commune governments. Table 1, below, gives some more details.

Benefits

The benefits are offered under two categories: hospitalization and outpatient care, as displayed in Table 2.



It shows that (a) a heavy emphasis is placed on the part of hospitalization benefit; (b) outpatient costs are only reimbursable when the treatment took place at a contracted commune medical centre and the reimbursement rate remains the lowest one, nevertheless, outpatient costs of five specified serious diseases, such as chronic renal failure are reimbursable now under the hospitalization category; (c) the general benefit level was largely improved in the second year of the operation due to a rise of 75 per cent in subsidy rate.
Furthermore, it should be noted that there are strict provisions on whether or not the incurred medical cost is reimbursable, depending on the category of medical institutes, medicines, services and laboratory tests, etc. In general, the reimbursable scope is much narrower than that stipulated under the urban health insurance schemes.

Organizational structure

Under the general leadership of the district government, the scheme is guided and supervised by the NRCMI leading group consisting of 14 institutional members, implemented by the Health Bureau, and managed by the management office set up under the Health Bureau. In addition, contributions are collected by the commune governments and a part of benefit claims are processed by contracted medical institutes.

Reimbursement procedure

Those insured can submit claims for reimbursement to the management office via the Internet at

External link to scheme homepage

or to the contracted medical institute where the treatment took place by presenting their personal NRCMI card issued by the management office. When it is processed by the medical institute, the amount of approved benefits will immediately be deducted from the bill and the insured patient pays only the remainder. Alternatively, the insured person pays the bill in full and is reimbursed later.Contracted medical institutes are required to send all related files on a monthly basis to the management office for endorsement. Any wrong payments will not be refunded.
Contracted medical institutes
Currently, a total of 74 medical institutes have been awarded a contract, including 50 commune medical centres, 11 district hospitals and 13 higher-level specialized hospitals located outside the district. Regular review and assessment of their performance is envisaged in the regulation. An unsatisfactory report may lead to the cancellation of their contract.

Progress achieved

Table 3 outlines the progress the Xiaoshan NRCMI scheme has achieved in terms of personal coverage, benefits paid and financial situation during the first two years of operation.



It demonstrates that (a) even at an early development stage, the actual coverage reached is as high as 90 per cent, if not more; (b) despite the large number of claims, 5 per cent got more than 80 per cent of the benefits. In respect of the actual reimbursement level, in terms of the amount of benefit granted as a percentage of all medical costs, it ranged, on average, from 14.81 per cent in the Linjiang Special Industrial Zone to 21.00 per cent in Xinjie Commune during the last quarter of 2005