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2020 Statistical Communiqué on the Development of National Medical Security Undertakings

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Medical Network News, June 11 On June 8, the National Medical Insurance Administration issued the "Statistical Communiqué on the Development of National Medical Security Undertakings in 2020".
The "Communiqué" disclosed that in 2020, three batches of national-organized drug centralized procurement will be carried out, involving 112 With an average price reduction of 54%, the actual purchase volume of selected drugs reached 2.
4 times the agreed purchase volume
.
The national organization of centralized procurement of coronary stents was carried out, and the average price of selected stents dropped from about 13,000 yuan to about 700 yuan
.
Procurement with volume has been fruitful and will continue to be normalized
.

The specific contents of the communiqué are as follows:

2020 is an extraordinary year in the history of New China.
Medical security departments at all levels across the country adhere to the guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, and implement the 19th National Congress of the Communist Party of China and the 2nd, 3rd and 4th National Congress of the 19th National Congress of the Communist Party of China.
The spirit of the Central and Fifth Plenary Sessions, adhere to the general keynote of the work of seeking progress while maintaining stability, coordinate the prevention and control of the epidemic and the high-quality development of medical security, strive to win the overall victory of medical insurance and poverty alleviation, do a solid job in the "six stability" work, and fully implement the "six guarantees" task , Actively build the framework of a medical security system with Chinese characteristics, unremittingly promote major reforms, achieve a stable operation of medical security, a safe and sustainable fund, and steady improvement in the benefits of the people, and significant progress has been made in the construction of a medical security system with Chinese characteristics
.

1.
Medical insurance

In 2020, 136.
131 million people will participate in the national basic medical insurance[1] (hereinafter referred to as basic medical insurance), and the insurance participation rate has stabilized at more than 95%
.
In 2020, the total income of the national basic medical insurance fund (including maternity insurance) was 2,484.
6 billion yuan, a year-on-year increase of 1.
7%, accounting for approximately 2.
4% of the year’s GDP; the total expenditure of the national basic medical insurance fund (including maternity insurance) was 21,032 billion yuan, a year-on-year increase of 1.
7%.
It increased by 0.
9% last year, accounting for approximately 2.
1% of GDP that year; the national basic medical insurance fund (including maternity insurance) accumulated a total of 3.
15 trillion yuan, of which the personal account balance of the basic medical insurance for employees (hereinafter referred to as employee medical insurance) was 109.
6 billion yuan
.

　　 (1) Basic medical insurance for employees

　　1.
The number of people participating in the insurance continues to increase
.
344.
55 million employees participated in medical insurance for employees, an increase of 15.
3 million or 4.
6% over the previous year
.
Among them, there were 254.
29 million employees, an increase of 5.
0% over the previous year; 90.
26 million retirees, an increase of 3.
7% over the previous year
.
The job-to-retirement ratio was 2.
82, an increase of 0.
04 from the previous year
.

　　2012-2020 Employee Medical Insurance Participants Structure Unit: 10,000

　　The three types of insured persons (including in-service employees and retirees) of enterprises , government agencies, and flexible employment were 233.
17 million, 63.
87 million, and 47.
51 million, respectively, an increase of 10.
5 million, 1.
55 million, There were 3.
25 million people, accounting for 67.
7%, 18.
5% and 13.
8% of the total number of people insured respectively.
The composition ratio was basically the same as that of the previous year
.
The number of employees participating in the medical insurance unified account and the single-built unified plan were 317.
35 million and 27.
2 million, respectively, accounting for 92.
1% and 7.
9% of the total number of employees participating in the medical insurance
.

　　Participants in employee medical insurance in 2020 Unit: 10,000

　　2.
The scale of fund revenue and expenditure is basically stable
.
In 2020, the income of the employee medical insurance fund (including maternity insurance) will be 1573.
2 billion yuan, a decrease of 0.
7% from the previous year[2]
.
Funds (including maternity insurance) expenditures were 1,286.
7 billion yuan, an increase of 1.
6% over the previous year
.
In 2020, the income of the employee medical insurance pooling fund (including maternity insurance) was 914.
5 billion yuan, a decrease of 8.
6% from the previous year; the expenditure of the pooling fund (including maternity insurance) was 793.
1 billion yuan, a decrease of 0.
1% from the previous year; the pooling fund (including maternity insurance) The current balance was 121.
4 billion yuan, and the accumulated balance (including maternity insurance) was 1,532.
7 billion yuan
.
In 2020, personal account income for employee medical insurance was 658.
7 billion yuan, an increase of 12.
8% over the previous year; personal account expenditures were 493.
6 billion yuan, an increase of 4.
5% over the previous year; the current balance of personal accounts was 165 billion yuan, and the cumulative balance was 109.
6 billion yuan
.

　　3.
The number of people enjoying benefits has decreased
.
Affected by the epidemic, the number of consultations in 2020 will decrease year-on-year
.
Participants in employee medical insurance enjoyed 1.
79 billion person-times, a decrease of 15.
6% over the previous year
.
Among them: 1.
5 billion general outpatient and emergency visits, a decrease of 16.
7% over the previous year; 230 million outpatient visits for chronic diseases, a decrease of 8.
8% over the previous year; 50 million inpatient visits, a decrease of 12.
3% over the previous year
.

　　Number of employee medical insurance benefits and per capita benefits from 2012 to 2020

　　In 2020, the average number of medical visits for employees covered by medical insurance was 5.
0, a decrease of 1.
4 from the previous year; the hospitalization rate was 15.
9%, a decrease of 2.
8 percentage points from the previous year
.
Among them: the hospitalization rate of employed employees was 8.
6%, a decrease of 1.
5 percentage points from the previous year; the hospitalization rate of retirees was 36.
0%, a decrease of 6.
5 percentage points from the previous year
.

　　Average hospitalization expenses and hospitalization rate of employee medical insurance from 2012 to 2020 Unit: Yuan

　　4.
The average hospitalization expenses per time continued to increase
.
In 2020, the average hospitalization cost per medical insurance for employees nationwide was 12,657 yuan, an increase of 6.
5% over the previous year
.

　　2012-2020 Average hospitalization expenses and overall planning fund expenditure unit of medical insurance for employees: Yuan

　　5.
The hospital reimbursement level remained stable
.
The hospitalization expense fund within the scope of the employee medical insurance policy pays 85.
2% [3]
.
The hospitalization expenses fund payment within the policy scope of secondary and lower-level medical institutions was 86.
9% and 88.
7%, respectively, which were 2.
6 and 4.
4 percentage points higher than those of tertiary medical institutions
.

　　The proportion of hospitalization expenses paid by medical institutions at all levels of employee medical insurance in 2020

　　In 2020, the total medical expenses of employees covered by medical insurance were 1,335.
7 billion yuan[4], a decrease of 4.
6% from the previous year, of which 1,1288.
1 billion yuan was incurred by medical institutions, and 207.
6 billion yuan was spent on personal accounts in pharmacies
.
Among the expenses incurred by medical institutions, the medical expenses of retirees were 668.
3 billion yuan, a decrease of 5.
3% from the previous year; the medical expenses of in-service employees were 459.
8 billion yuan, a decrease of 6.
5% from the previous year
.

　　 (2) Basic medical insurance for urban and rural residents[5]

　　1.
The number of people participating in the insurance has decreased slightly
.
In 2020, 1,066 million people participated in the national basic medical insurance for urban and rural residents (hereinafter referred to as resident medical insurance), a decrease of 0.
8% over the previous year
.
Among them, adults, elementary and middle school students and children, and college students were 750.
1 million, 246.
1 million, and 20.
56 million, respectively, representing an increase of -2.
5%, 4.
6%, and 1.
7% over the previous year, accounting for 73.
8% and 24.
2% of the total number of people insured.
, 2.
0%
.

　　2.
The scale of fund income continues to expand
.
In 2020, the income of the residents' medical insurance fund was 911.
5 billion yuan and the expenditure was 816.
5 billion yuan, an increase of 6.
3% and -0.
3% respectively over the previous year
.
In 2020, the current balance of the resident medical insurance fund will be 94.
9 billion yuan, and the cumulative balance will be 607.
7 billion yuan
.
In 2020, the resident medical insurance will raise an average of 833 yuan per capita
.

　　2012-2020 Resident Medical Insurance Fund Revenue and Expenditure Unit: 100 million yuan

　　3.
The number of people enjoying treatment and medical expenses have decreased
.
Affected by the epidemic, in 2020, resident medical insurance participants will receive a total of 1.
99 billion person-times, a decrease of 8.
4% from the previous year
.
Resident medical insurance per capita enjoyed outpatient treatment 1.
80 times, a decrease of 0.
15 times from the previous year
.
In 2020, the medical expenses of residents' medical insurance will be 1,408 trillion yuan, a decrease of 2.
3% over the previous year
.

　　2012-2020 Resident Medical Insurance Benefits Unit: 10,000 person-times

　　4.
The hospitalization rate has declined
.
The hospitalization rate of residents covered by medical insurance was 15.
1%, a decrease of 1.
5 percentage points from the previous year; the average hospital stay was 9.
2 days, the same as the previous year; the average hospitalization expense was 7,546 yuan, an increase of 7.
1% over the previous year
.
Among them, the average hospitalization expenses in tertiary, secondary, primary and lower medical institutions were 13,533 yuan, 6464 yuan, and 3237 yuan, respectively, an increase of 9.
6%, 6.
4%, and -1.
3% over the previous year
.

　　2012-2020 Average hospitalization expenses and hospitalization rate of residents with medical insurance from 2012 to 2020 Unit: Yuan

　　5.
The hospital reimbursement level increased steadily
.
Within the scope of the resident medical insurance policy, the hospitalization expense fund paid 70.
0%, an increase of 1.
2% over the previous year
.
According to the level of medical institutions, the hospitalization expense fund payment within the policy scope is: 65.
1% for the third level, 73.
0% for the second level, and 79.
8% for the first level and below
.
Among them, 74.
6% of the funds paid within the policy scope of secondary medical institutions and below are 9.
5 percentage points higher than that of tertiary medical institutions
.

　　The proportion of hospitalization expenses paid by resident medical insurance at all levels of medical institutions in 2020

　　 (3) Maternity Insurance

　　In 2020, 235.
67 million people nationwide participated in maternity insurance[6], an increase of 10.
0% over the previous year
.
11.
67 million person-times enjoyed various maternity insurance benefits, an increase of 304,000 person-times over the previous year and an increase of 2.
7% over the previous year
.
The per capita maternity treatment expenditure of maternity insurance [7] was 2,1973 yuan, an increase of 8.
2% over the previous year
.

　　2.
Medical aid and medical insurance for poverty alleviation

　　In 2020, the National Medical Assistance Fund spent 54.
684 billion yuan, subsidized 99.
84 million people to participate in basic medical insurance, and provided 84.
04 million outpatient and inpatient assistance.
The national average hospitalization assistance and outpatient assistance were RMB 1,056 and RMB 93 respectively
.
In 2020, the central government will invest 26 billion yuan in medical assistance subsidies, an increase of 6% over last year, and another 4 billion yuan will be allocated to improve the medical security level of the rural poor in deeply impoverished areas such as the "three districts and three states", and 1.
5 billion will be allocated Yuan special transfer payment for medical assistance subsidy funds
.

　　In 2020, the insurance participation rate of the poverty-stricken people in rural areas who have registered for registration will stabilize at over 99.
9%
.
Since 2018, various medical insurance and poverty alleviation policies have benefited a total of 530 million people from poor people seeking medical care, helping nearly 10 million families with poverty-stricken families to get rid of poverty
.

　　3.
List of medical insurance drugs

　　After the 2020 National Medical Insurance Drug List was adjusted, a total of 119 new drugs were added to the list, and 29 drugs in the original list were removed from the list
.
In this adjustment, a total of 119 drugs were successfully negotiated, with an average price reduction of 50.
6%
.
The adjusted "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2020)" contains a total of 2,800 types of Western medicines and proprietary Chinese medicines, of which 1,426 are Western medicines and 1,374 are Chinese patent medicines
.
There are 892 kinds of Chinese herbal medicines in the catalog
.

　　4.
Drug procurement

　　In 2020, the total amount of online procurement orders nationwide through the provincial centralized drug procurement platform was 931.
2 billion yuan, a decrease of 60.
1 billion yuan from 2019
.
Among them, western medicine (chemical drugs and biological products) was 752.
1 billion yuan, and Chinese patent medicine was 179.
1 billion yuan, a decrease of 59.
4 billion yuan and 700 million yuan respectively from 2019
.
The drugs in the medical insurance catalog accounted for 86.
5% of the total online procurement orders, and the amount was 805.
2 billion yuan
.

　　In 2020, three batches of national-organized drug centralized procurement will be carried out, involving 112 varieties, and the average price will be reduced by 54%.
The actual procurement volume of selected drugs will reach 2.
4 times the agreed procurement volume
.
The national organization of centralized procurement of coronary stents was carried out, and the average price of selected stents dropped from about 13,000 yuan to about 700 yuan
.

　　5.
Medical insurance payment reform

　　Continue to advance the reform of payment methods, launch DRG payment national pilot work in 30 cities, all 30 pilot cities have passed the evaluation and assessment before simulation operation, and entered the simulation operation stage; carry out regional point method total budget and DIP payment pilot work in 71 cities
.

　　6.
Seek medical treatment in a different place

　　In 2020, there will be 48.
31 million medical insurance insured persons seeking medical treatment in different places and 133.
8 billion yuan of medical expenses.
Among them, 6.
09 million hospitalizations and medical expenses will be 118.
8 billion yuan
.
Resident medical insurance participants received 34.
07 million medical visits in different places, and the cost of medical treatment in other places was 262.
3 billion yuan, of which 15.
35 million were hospitalized and medical treatment expenses were 250.
5 billion yuan
.

　　In 2020, the number of designated medical institutions for direct settlement of hospitalization expenses across provinces and other places will be 44,413; the number of valid records on the national platform is 7.
71 million
.
In the whole year, 5.
85 million hospitalizations were hospitalized across provinces and other places for medical treatment, of which 3.
0023 million were directly settled across provinces, medical expenses were settled directly across provinces 74.
28 billion yuan, and funds paid 43.
873 billion yuan
.
In 12 pilot provinces including the Beijing-Tianjin-Hebei, the Yangtze River Delta, and the five southwestern provinces, the total direct settlement of ordinary outpatient expenses across the provinces reached 3.
02 million.
The total medical expenses were 746 million yuan, and the medical insurance fund paid 429 million yuan
.

　　7.
Supervision of Medical Security Fund

　　We continued to carry out special measures to combat fraudulent acquisition of medical security funds.
In the whole year, medical insurance departments at all levels inspected 627,000 designated medical institutions, investigated and dealt with 401,000 medical institutions that violated laws and regulations, among which 6,008 medical insurance agreements were lifted, 5457 were administrative penalties, and they were transferred to justice There were 286 agencies; a total of 26,100 people insured who violated laws and regulations were handled in various places, of which 3162 were suspended from settlement and 2062 were transferred to judicial organs; a total of 22.
31 billion yuan was recovered in the whole year
.

　　The National Medical Insurance Bureau organized a total of 61 unannounced inspection teams to conduct on-site inspections in various provinces across the country.
The unannounced inspection teams inspected 91 designated medical institutions (including medical and elderly care institutions), 56 medical insurance agencies, and undertook medical insurance for urban and rural residents and major diseases.
Forty commercial insurance companies insured have found a total of 540 million yuan in funds suspected of violating laws and regulations
.

　　8.
Long-term care insurance

　　In 2020, the number of long-term care insurance participants was 10.
8533 million, and the number of people enjoying benefits was 835,000
.
In 2020, fund income will be 19.
61 billion yuan and fund expenditure will be 13.
14 billion yuan
.
There are 4,845 designated nursing service institutions for long-term care insurance
.
The number of nursing service staff is 191,000
.

　　Note: Part of the data in this bulletin is rounded, and the total is slightly different from the sub-total
.

　　 [1] National basic medical insurance includes basic medical insurance for employees and basic medical insurance for urban and rural residents
.
The maternity insurance fund is merged into the basic medical insurance fund for employees, and the income from the maternity insurance fund is no longer listed separately, and the maternity treatment expenditure item is set up in the treatment expenditure of the basic medical insurance fund for employees
.

　　 [2] Affected by the epidemic, from February to July 2020 across the country, a phased halving of employee medical insurance unit contributions was implemented in many parts of the country, with a cumulative reduction of about 164.
9 billion yuan, and employee medical insurance income decreased from the previous year
.
Excluding the impact of the reduction factor, the total income of the employee medical insurance fund (including maternity insurance) increased by 9.
6% over the previous year
.

　　 [3] From 2019, within the scope of the policy, the calculation caliber of the hospitalization expense fund payment ratio and the actual hospitalization expense fund expenditure ratio has been adjusted, which is the full range of fund expenditures, and personal account expenditures are included in the fund expenditure statistics, that is, fund expenditures are the overall fund, personal accounts, The sum of payments from other funds such as supplementary medical insurance
.
The caliber of personal burden calculation is adjusted accordingly, and personal account expenditures are not included in the personal burden statistics
.

　　 [4] The total medical expenses of employee medical insurance include general outpatient and emergency expenses, outpatient and serious illness expenses, hospitalization expenses and personal account expenses in designated retail pharmacies
.
Except for this item, other data on medical insurance related expenses and benefits of employees do not include expenses incurred in designated retail pharmacies
.

　　 [5] Since 2013, provinces have integrated the two systems of urban residents’ medical insurance and the new rural cooperative medical insurance system in accordance with national requirements, and established a unified urban and rural residents’ medical insurance.
Big
.
In this bulletin, unless otherwise specified, the relevant indicator data of the basic medical insurance for urban and rural residents in 2018 and before do not include the unintegrated new rural cooperative medical insurance system that year
.

　　 [6] Note: The coverage of maternity insurance covers the employees of the unit, excluding retirees
.

　　 [7] Note: Maternity medical expenses and maternity allowances for female employees (maternity leave, alternative wages during leave for family planning surgery)
.

　　The specific contents of the communiqué are as follows:

　　1.
Medical insurance