Financing and benefits among three social health insurance schemes
| UEBMI | URBMI | NCMS | |
| Eligible population | Employed urban residents | Unemployed urban residents | Rural residents |
| Unit of funding pool7 | Municipal city (n=333) | Municipal city (n=333) | Rural county (n=2852) |
| Source of funding7 | 8% of employees’ annual wage (6% from employers, and 2% from employees) | Government subsidy (70%) and unemployed urban residents’ premium (30%) | Government subsidy (80%) and rural residents’ premium (20%) |
| National average premium per capita in 2014 (US$)8 | 418 | 238 | 60 |
| National average ceiling in 2008 (US$)6 | 14 706 | 11 765 | 2941 |
| Reimbursement rate in 2008 (%)6 | 72 | 50 | 40 |
| Service package covered | Comprehensive (outpatient and inpatient services) | Limited (outpatient services are restricted) | Limited (outpatient services are restricted) |
| Average number of drugs covered7 | 2300 | 2300 | 800 |
| Restrictions on the facilities in which insured can claim reimbursements | Reimbursements can be claimed for health services in designated facilities. The majority of designated facilities locate within the unit of funding pool. Insured use services in designated facilities within the unit of funding pool can claim higher reimbursements than their counterparts who use out-of-unit services. | ||
Source of data: refs6–8.
US$1=¥6.8.
NCMS, new rural cooperative medical scheme; UEBMI, urban employee-based basic medical insurance; URBMI, urban resident-based basic medical insurance.