Employee medical insurance fund expenditures increased by 1.6%, 390,000 pharmacies affected

The National Medical Insurance Bureau released the "Statistical Bulletin on the Development of National Medical Security Undertakings in 2020" on June 11 by the National Medical Insurance Bureau.
The national employee medical insurance fund expenditure increased by 1.
6% year-on-year, which was not as high as the 10.
4% increase in 2019.
390,000 designated medical insurance pharmacies across the country were affected
.

 

In 2020 , 1.
361 billion people participated in the national medical insurance

 

On June 8, the National Medical Insurance Administration announced the "Statistical Communiqué on the Development of National Medical Security Undertakings in 2020" (hereinafter referred to as the "Report")
.

 

According to the report, the number of people participating in national medical insurance in 2020 is 1.
361 billion, and the participation rate is stable at over 95%
.
The total income of the national basic medical insurance fund (including maternity insurance) was 2,484.
6 billion yuan, an increase of 1.
7% over the previous year, and the total expenditure was 213.
2 billion yuan, an increase of 0.
9% over the previous year; the cumulative balance was 3.
150 billion yuan, of which the cumulative balance of employee medical insurance personal accounts was 10,096 100 million yuan
.

 

　　Employee medical insurance fund expenditures increased by 1.
6% , 390,000 pharmacies were affected

 

　　The report shows that in terms of employee medical insurance, 344.
55 million people participated in employee medical insurance nationwide, an increase of 15.
3 million or 4.
6% over the previous year
.
Among them, the number of in-service employees was 254.
29 million, an increase of 5.
0% over the previous year; and the number of retired employees was 90.
26 million, 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
.

 

　　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
.
Funds (including maternity insurance) expenditures were 1,286.
7 billion yuan, an increase of 1.
6% over the previous year
.
It should be noted that in 2019, the income of the employee medical insurance fund (including maternity insurance) was 1,584.
5 billion yuan, an increase of 10.
7% over the previous year; the fund (including maternity insurance) expenditure was 1,266.
3 billion yuan, an increase of 10.
4% over the previous year
.

 

　　It can be seen that the income of the employee medical insurance fund will decline in 2020, and the expenditure will only increase by 1.
6%, which is much slower than the 10.
4% increase in expenditure in 2019
.
According to a person from the State Food and Drug Administration, there will be approximately 390,000 designated retail pharmacies nationwide in 2020, and the decline in employee medical insurance fund expenditures will directly affect the future performance of these pharmacies
.

 

　　According to the report on the number of employees participating in medical insurance for 2020, among the 344.
55 million employees participating in employee medical insurance, there are 233.
17 million and 63.
87 million insured persons (including in-service employees and retirees) of the three types of insured persons (including in-service employees and retirees) including enterprises , institutions, and flexible employment.
There were 10.
5 million, 1.
55 million, and 3.
25 million more than the previous year, accounting for 67.
7%, 18.
5%, and 13.
8% of the total number of people participating in the insurance.
The composition ratio was basically the same as that of the previous year
.

 

　　Participants in employee medical insurance in 2020 (unit: ten thousand people)

　　The structure of employees participating in medical insurance from 2012 to 2020 (unit: ten thousand people)

　　 (Image source: National Medical Insurance Administration)

 

　　In 2020, the total medical expenses of employees covered by medical insurance will be 1,335.
7 billion yuan, a decrease of 4.
6% from the previous year
.
Among them, the expenses incurred by medical institutions were 1,128.
1 billion yuan, accounting for 84.
46%, which was a decrease of 5.
76% compared to 2019 expenses; personal accounts spent 207.
6 billion yuan in pharmacies , accounting for 15.
54%, which was an increase of 2.
32% compared to 2019 expenses
.

 

　　In addition, in 2020, employee medical insurance personal account income 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; personal account balances for the current period were 165 billion yuan, with a cumulative balance of 1009.
6 billion yuan
.

 

　　It is worth mentioning that in April 2021, the General Office of the State Council issued a document stating that it is necessary to improve the accounting method for employees’ medical insurance personal accounts.
In-service employees’ personal accounts are included in the basic medical insurance premiums paid by individuals, and the accounting standard is controlled in principle.
Within 2% of the insurance payment base, all basic medical insurance premiums paid by the unit are included in the overall planning fund
.
In addition, the employee medical insurance personal account can not only be used for the insured person himself, but also can pay for the expenses of medical treatment, medical equipment and consumables incurred by his spouse, parents, and children at designated medical institutions and designated pharmacies (which need to be borne by the individual)
.

 

　　Regarding the reform of individual medical insurance accounts, Xie Zilong, chairman of the common people’s pharmacy, once said that the current medical insurance funds are relatively surplus, but under the general trend of individual medical insurance account reforms, pharmacy sales will be greatly fluctuated, and the entire industry has a buffer of two to three years.
Period
.

 

　　The number of adult urban and rural residents participating in the insurance decreased by 2.
5% year-on-year

 

　　In terms of urban and rural medical insurance, the number of people participating in the national medical insurance for urban and rural residents was 1.
016.
76 million, 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%
.
among them,

 

　　It is worth noting that in 2020, the number of adults with the largest proportion of urban and rural residents' medical insurance has shown a negative increase in the number of insured persons.
In similar data in 2019, the number of adults participating in urban and rural medical insurance was 769.
42 million, a year-on-year increase of 16.
1%.
The growth rate exceeds that of primary and middle school students and children (10.
1%) and the group of college students (-2.
9%)
.
In addition, in 2019, the adult population accounted for 75.
1% of the number of people participating in urban and rural medical insurance that year.
In 2020, this figure has dropped to 73.
8%
.

 

　　In 2020, the income of the medical insurance fund for urban and rural residents was 911.
5 billion yuan, an increase of 6.
3% from the previous year, and the expenditure was 816.
5 billion yuan, a decrease of 0.
3% from the previous year; the current balance of the medical insurance fund for urban and rural residents was 94.
9 billion yuan, and the cumulative balance was 607.
7 billion yuan.
The average capital raised is 833 yuan per capita
.

 

　　2012-2020 Urban and Rural Residents' Medical Insurance Fund Revenue and Expenditure (Unit: 100 million yuan)

　　 (Image source: National Medical Insurance Administration)

 

　　As early as June 2019, the National Medical Insurance Administration issued the "Notice on Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 2019", stating that the implementation of individual (family) accounts should be cancelled before the end of 2020, and the smooth transition to outpatient coordination should be implemented.
This will not reduce the residents' medical insurance benefits
.

 

　　The average price of medicines in the medical insurance catalogue has been reduced by 50.
6%

 

　　In terms of the medical insurance drug catalogue and drug procurement , after the 2020 National Medical Insurance Drug Catalogue was adjusted, a total of 119 new drugs were added to the catalog, and 29 drugs in the original catalog were removed from the catalog
.
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, an increase of 91 types from last year
.
Among them, there are 1,426 kinds of western medicines, 56 kinds more than last year; 1,374 kinds of Chinese patent medicines, 35 kinds more than last year; 892 kinds of Chinese herbal medicine pieces in the catalog, which are the same as last year
.

 

　　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
.
In the three batches of national centralized procurement, 112 varieties were involved, and the average price was reduced by 54%.
The actual procurement volume of selected drugs reached 2.
4 times the agreed procurement volume
.

 

　　627,000 designated medical institutions, more than half defaulted

 

　　In terms of medical insurance fund supervision, a total of 22.
31 billion yuan was recovered in 2020
.
In 2020, 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 penalized, and 286 were transferred to judicial organs
.

 

　　In terms of personnel accountability, in 2020, a total of 26,100 people insured who violated laws and regulations were handled in various places, of which 3,162 were suspended for settlement and 2,062 were transferred to judicial organs
.

 

　　It is worth mentioning that the "Regulations on the Supervision and Administration of the Use of the Medical Security Fund" have been formally implemented on May 1 this year
.
Shi Zihai, deputy director of the National Medical Insurance Administration, publicly stated that more than half of the designated medical institutions have problems with the use of medical insurance funds to varying degrees.
The Regulations on the Supervision and Administration of the Use of Medical Security Funds have increased penalties for illegal use of medical insurance funds and increased the deterrence of the law.
In addition, the corresponding legal responsibilities have been detailed for the illegal activities of medical insurance agencies, designated medical institutions, and insured individuals, and severe penalties have been imposed on fraudulent insurance fraud
.

 

　　Since the implementation of the Regulations on the Supervision and Administration of the Use of Medical Security Funds, many pharmacies across the country have frequently exposed cases of violations, and the medical insurance department has become increasingly strict in the management and supervision of designated pharmacies
.

　　The National Medical Insurance Bureau released the "Statistical Bulletin on the Development of National Medical Security Undertakings in 2020" on June 11 by the National Medical Insurance Bureau.
The national employee medical insurance fund expenditure increased by 1.
6% year-on-year, which was not as high as the 10.
4% increase in 2019.
390,000 designated medical insurance pharmacies across the country were affected
.

 

　　In 2020 , 1.
361 billion people participated in the national medical insurance

 

　　On June 8, the National Medical Insurance Administration announced the "Statistical Communiqué on the Development of National Medical Security Undertakings in 2020" (hereinafter referred to as the "Report")
.

 

　　According to the report, the number of people participating in national medical insurance in 2020 is 1.
361 billion, and the participation rate is stable at over 95%
.
The total income of the national basic medical insurance fund (including maternity insurance) was 2,484.
6 billion yuan, an increase of 1.
7% over the previous year, and the total expenditure was 213.
2 billion yuan, an increase of 0.
9% over the previous year; the cumulative balance was 3.
150 billion yuan, of which the cumulative balance of employee medical insurance personal accounts was 10,096 100 million yuan
.

 

　　Employee medical insurance fund expenditures increased by 1.
6% , 390,000 pharmacies were affected

 

　　The report shows that in terms of employee medical insurance, 344.
55 million people participated in employee medical insurance nationwide, an increase of 15.
3 million or 4.
6% over the previous year
.
Among them, the number of in-service employees was 254.
29 million, an increase of 5.
0% over the previous year; and the number of retired employees was 90.
26 million, 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
.

 

　　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
.
Funds (including maternity insurance) expenditures were 1,286.
7 billion yuan, an increase of 1.
6% over the previous year
.
It should be noted that in 2019, the income of the employee medical insurance fund (including maternity insurance) was 1,584.
5 billion yuan, an increase of 10.
7% over the previous year; the fund (including maternity insurance) expenditure was 1,266.
3 billion yuan, an increase of 10.
4% over the previous year
.

 

　　It can be seen that the income of the employee medical insurance fund will decline in 2020, and the expenditure will only increase by 1.
6%, which is much slower than the 10.
4% increase in expenditure in 2019
.
According to a person from the State Food and Drug Administration, there will be approximately 390,000 designated retail pharmacies nationwide in 2020, and the decline in employee medical insurance fund expenditures will directly affect the future performance of these pharmacies
.

 

　　According to the report on the number of employees participating in medical insurance for 2020, among the 344.
55 million employees participating in employee medical insurance, there are 233.
17 million and 63.
87 million insured persons (including in-service employees and retirees) of the three types of insured persons (including in-service employees and retirees) including enterprises , institutions, and flexible employment.
There were 10.
5 million, 1.
55 million, and 3.
25 million more than the previous year, accounting for 67.
7%, 18.
5%, and 13.
8% of the total number of people participating in the insurance.
The composition ratio was basically the same as that of the previous year
.

 

　　Participants in employee medical insurance in 2020 (unit: ten thousand people)

　　The structure of employees participating in medical insurance from 2012 to 2020 (unit: ten thousand people)

　　 (Image source: National Medical Insurance Administration)

 

　　In 2020, the total medical expenses of employees covered by medical insurance will be 1,335.
7 billion yuan, a decrease of 4.
6% from the previous year
.
Among them, the expenses incurred by medical institutions were 1,128.
1 billion yuan, accounting for 84.
46%, which was a decrease of 5.
76% compared to 2019 expenses; personal accounts spent 207.
6 billion yuan in pharmacies , accounting for 15.
54%, which was an increase of 2.
32% compared to 2019 expenses
.

 

　　In addition, in 2020, employee medical insurance personal account income 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; personal account balances for the current period were 165 billion yuan, with a cumulative balance of 1009.
6 billion yuan
.

 

　　It is worth mentioning that in April 2021, the General Office of the State Council issued a document stating that it is necessary to improve the accounting method for employees’ medical insurance personal accounts.
In-service employees’ personal accounts are included in the basic medical insurance premiums paid by individuals, and the accounting standard is controlled in principle.
Within 2% of the insurance payment base, all basic medical insurance premiums paid by the unit are included in the overall planning fund
.
In addition, the employee medical insurance personal account can not only be used for the insured person himself, but also can pay for the expenses of medical treatment, medical equipment and consumables incurred by his spouse, parents, and children at designated medical institutions and designated pharmacies (which need to be borne by the individual)
.

 

　　Regarding the reform of individual medical insurance accounts, Xie Zilong, chairman of the common people’s pharmacy, once said that the current medical insurance funds are relatively surplus, but under the general trend of individual medical insurance account reforms, pharmacy sales will be greatly fluctuated, and the entire industry has a buffer of two to three years.
Period
.

 

　　The number of adult urban and rural residents participating in the insurance decreased by 2.
5% year-on-year

 

　　In terms of urban and rural medical insurance, the number of people participating in the national medical insurance for urban and rural residents was 1.
016.
76 million, 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%
.
among them,

 

　　It is worth noting that in 2020, the number of adults with the largest proportion of urban and rural residents' medical insurance has shown a negative increase in the number of insured persons.
In similar data in 2019, the number of adults participating in urban and rural medical insurance was 769.
42 million, a year-on-year increase of 16.
1%.
The growth rate exceeds that of primary and middle school students and children (10.
1%) and the group of college students (-2.
9%)
.
In addition, in 2019, the adult population accounted for 75.
1% of the number of people participating in urban and rural medical insurance that year.
In 2020, this figure has dropped to 73.
8%
.

 

　　In 2020, the income of the medical insurance fund for urban and rural residents was 911.
5 billion yuan, an increase of 6.
3% from the previous year, and the expenditure was 816.
5 billion yuan, a decrease of 0.
3% from the previous year; the current balance of the medical insurance fund for urban and rural residents was 94.
9 billion yuan, and the cumulative balance was 607.
7 billion yuan.
The average capital raised is 833 yuan per capita
.

 

　　2012-2020 Urban and Rural Residents' Medical Insurance Fund Revenue and Expenditure (Unit: 100 million yuan)

　　 (Image source: National Medical Insurance Administration)

 

　　As early as June 2019, the National Medical Insurance Administration issued the "Notice on Doing a Good Job in Basic Medical Security for Urban and Rural Residents in 2019", stating that the implementation of individual (family) accounts should be cancelled before the end of 2020, and the smooth transition to outpatient coordination should be implemented.
This will not reduce the residents' medical insurance benefits
.

 

　　The average price of medicines in the medical insurance catalogue has been reduced by 50.
6%

 

　　In terms of the medical insurance drug catalogue and drug procurement , after the 2020 National Medical Insurance Drug Catalogue was adjusted, a total of 119 new drugs were added to the catalog, and 29 drugs in the original catalog were removed from the catalog
.
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, an increase of 91 types from last year
.
Among them, there are 1,426 kinds of western medicines, 56 kinds more than last year; 1,374 kinds of Chinese patent medicines, 35 kinds more than last year; 892 kinds of Chinese herbal medicine pieces in the catalog, which are the same as last year
.

 

　　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
.
In the three batches of national centralized procurement, 112 varieties were involved, and the average price was reduced by 54%.
The actual procurement volume of selected drugs reached 2.
4 times the agreed procurement volume
.

 

　　627,000 designated medical institutions, more than half defaulted

 

　　In terms of medical insurance fund supervision, a total of 22.
31 billion yuan was recovered in 2020
.
In 2020, 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 penalized, and 286 were transferred to judicial organs
.

 

　　In terms of personnel accountability, in 2020, a total of 26,100 people insured who violated laws and regulations were handled in various places, of which 3,162 were suspended for settlement and 2,062 were transferred to judicial organs
.

 

　　It is worth mentioning that the "Regulations on the Supervision and Administration of the Use of the Medical Security Fund" have been formally implemented on May 1 this year
.
Shi Zihai, deputy director of the National Medical Insurance Administration, publicly stated that more than half of the designated medical institutions have problems with the use of medical insurance funds to varying degrees.
The Regulations on the Supervision and Administration of the Use of Medical Security Funds have increased penalties for illegal use of medical insurance funds and increased the deterrence of the law.
In addition, the corresponding legal responsibilities have been detailed for the illegal activities of medical insurance agencies, designated medical institutions, and insured individuals, and severe penalties have been imposed on fraudulent insurance fraud
.

 

　　Since the implementation of the Regulations on the Supervision and Administration of the Use of Medical Security Funds, many pharmacies across the country have frequently exposed cases of violations, and the medical insurance department has become increasingly strict in the management and supervision of designated pharmacies
.