Table 1

Financing and benefits among three social health insurance schemes

Eligible populationEmployed urban residentsUnemployed urban residentsRural residents
Unit of funding pool7Municipal city (n=333)Municipal city (n=333)Rural county (n=2852)
Source of funding78% 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$)841823860
National average ceiling in 2008 (US$)614 70611 7652941
Reimbursement rate in 2008 (%)6725040
Service package coveredComprehensive (outpatient and inpatient services)Limited (outpatient services are restricted)Limited (outpatient services are restricted)
Average number of drugs covered723002300800
Restrictions on the facilities in which insured can claim reimbursementsReimbursements 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.