China: employee basic medical insurance fund income and expenditure by account
In 2021, the Chinese employee basic medical insurance fund received an overall income exceeding 1,900 billion yuan, while spending around 1,475 billion yuan.
Personal accounts and the pooled fund
Every employee insured via the employee basic medical insurance program is assigned a personal account to cover the expenses of most outpatient services. Outpatient bills for serious diseases, inpatient care, and surgeries are reimbursed through the pooled fund, which is financed by mandatory contributions from employers. This system results in many patients, who regularly visit outpatient services, having no funds in their personal accounts and having to pay out-of-pocket, while the funds in the personal accounts of healthier people remain largely unutilized.
Better than the resident basic medical insurance
As the employee basic medical insurance program is funded by the mandatory contributions of the employers and employees, it receives significantly higher incomes than the urban and rural resident basic medical insurance program, which covers more than one billion non-working citizens such as children, students, and rural residents across China. Compared to the employee basic medical insurance, the resident basic medical insurance is more affordable, yet its reimbursement rates can be significantly lower, with many services and medications not covered, depending on the local economic situation. Poverty caused by unaffordable out-of-pocket medical costs remains a significant challenge in many regions across China.