Opinions on Enhancing the Administration of the Basic Medical Insurance Fund Budget to Give Play to the Role of the Medical Insurance Fund concerning Expenditure Control
Opinions on Enhancing the Administration of the Basic Medical Insurance Fund Budget to Give Play to the Role of the Medical Insurance Fund concerning Expenditure Control
Opinions on Enhancing the Administration of the Basic Medical Insurance Fund Budget to Give Play to the Role of the Medical Insurance Fund concerning Expenditure Control
Cai She [2016] No.242
December 29, 2016
Finance departments (bureaus), departments (bureaus) of human resources and social security and health and family planning commissions of, and financial supervision commissioner offices of the Ministry of Finance in all provinces, autonomous regions and municipalities directly under the Central Government,
Since its establishment, China's basic medical insurance system has seen the continuous expansion in the coverage and gradual improvement in guarantee level and has been playing an important role in ensuring the fulfillment of the basic medical needs of the insured and improving the level of public health, but is also faced with such issues as unreasonable increase in medical expenses and build-up of the pressure on fund operation and has the risk of medium or long-term unsustainability. The unreasonable increase in medical expenses has offset the effect of government input, making social and individual burdens heavier. The following opinions are hereby rendered in accordance with the Budget Law, the Social Insurance Law and the relevant provisions of the State Council, in order to strengthen the administration of the budget for revenues and expenditures with regard to the basic medical insurance fund, control the unreasonable increase in medical expenses, reduce individual burden, and ensure the sustainable operation of the basic medical insurance system and fund.
I. Strengthening the Administration of the Budget for Revenues and Expenditures with regard to the Basic Medical Insurance Fund
1. Preparing reasonable budgets for revenues and expenditures. All pooling regions must prepare their budgets for revenues and expenditures strictly in line with the principle of "determining expenditures according to revenues and maintaining a balance between revenues and expenditures with a slight surplus". The revenue budget for the basic medical insurance fund shall be prepared in a comprehensive, accurate and complete manner based on such factors as the base for premium payment (or standard for premium payment), rate of premium payment and number of insureds. Local finance departments at all levels shall, in accordance with the provisions, arrange the full budget for expenditures related to premium payment by administrative institutions that participate in the basic medical insurance scheme and arrange the full budget for subsidy expenditures of the government with respect to urban and rural residents covered by the basic medical insurance at a standard not lower than the standard specified by the State and the proportion of sharing by the central and local departments concerned. The annual expenditure budget shall be prepared by comprehensively considering such factors as the expenditure scale in previous years, level of local medical expenses, objective of control over medical expenses, age structure of the insured, number of people enjoying benefits, and adjustments to the benefit policy. In principle, the deficit budget for the current year and the accumulative surplus and deficit budget for the fund over the years shall not be prepared. Except for the expenditures in connection with basic medical insurance benefits, critical illness insurance, transfer, turning over of tax revenues to governments at higher levels and subsidies granted to governments at higher levels, no any other expenditure budget may be prepared in principle. Where it is really necessary to prepare any other expenditure budget or accumulative surpluses over the years need to be used to make up for expenditures in the current year at the time of budget preparation, such preparation or use attached with detailed descriptions must conform to the relevant provisions of the financial system for the social insurance fund and be reported to the people's government at the same level for approval.
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Cai She [2016] No.242
December 29, 2016
Finance departments (bureaus), departments (bureaus) of human resources and social security and health and family planning commissions of, and financial supervision commissioner offices of the Ministry of Finance in all provinces, autonomous regions and municipalities directly under the Central Government,
Since its establishment, China's basic medical insurance system has seen the continuous expansion in the coverage and gradual improvement in guarantee level and has been playing an important role in ensuring the fulfillment of the basic medical needs of the insured and improving the level of public health, but is also faced with such issues as unreasonable increase in medical expenses and build-up of the pressure on fund operation and has the risk of medium or long-term unsustainability. The unreasonable increase in medical expenses has offset the effect of government input, making social and individual burdens heavier. The following opinions are hereby rendered in accordance with the Budget Law, the Social Insurance Law and the relevant provisions of the State Council, in order to strengthen the administration of the budget for revenues and expenditures with regard to the basic medical insurance fund, control the unreasonable increase in medical expenses, reduce individual burden, and ensure the sustainable operation of the basic medical insurance system and fund.
I. Strengthening the Administration of the Budget for Revenues and Expenditures with regard to the Basic Medical Insurance Fund
1. Preparing reasonable budgets for revenues and expenditures. All pooling regions must prepare their budgets for revenues and expenditures strictly in line with the principle of "determining expenditures according to revenues and maintaining a balance between revenues and expenditures with a slight surplus". The revenue budget for the basic medical insurance fund shall be prepared in a comprehensive, accurate and complete manner based on such factors as the base for premium payment (or standard for premium payment), rate of premium payment and number of insureds. Local finance departments at all levels shall, in accordance with the provisions, arrange the full budget for expenditures related to premium payment by administrative institutions that participate in the basic medical insurance scheme and arrange the full budget for subsidy expenditures of the government with respect to urban and rural residents covered by the basic medical insurance at a standard not lower than the standard specified by the State and the proportion of sharing by the central and local departments concerned. The annual expenditure budget shall be prepared by comprehensively considering such factors as the expenditure scale in previous years, level of local medical expenses, objective of control over medical expenses, age structure of the insured, number of people enjoying benefits, and adjustments to the benefit policy. In principle, the deficit budget for the current year and the accumulative surplus and deficit budget for the fund over the years shall not be prepared. Except for the expenditures in connection with basic medical insurance benefits, critical illness insurance, transfer, turning over of tax revenues to governments at higher levels and subsidies granted to governments at higher levels, no any other expenditure budget may be prepared in principle. Where it is really necessary to prepare any other expenditure budget or accumulative surpluses over the years need to be used to make up for expenditures in the current year at the time of budget preparation, such preparation or use attached with detailed descriptions must conform to the relevant provisions of the financial system for the social insurance fund and be reported to the people's government at the same level for approval.
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