Progress and policy implication of the Insurance Programs for Catastrophic Diseases in China

The State Council encouraged the involvement of commercial insurance companies (CICs) in the development of the Insurance Program for Catastrophic Diseases (IPCD), yet its implementation has rarely been reported. We collected literature and policy documentation and conducted interviews in 10 cities with innovative IPCD policies to understand the details of the implementation of IPCD. IPCDs are operated at the prefectural level in 14 provinces, while in 4 municipalities and 6 provinces, unified IPCDs have been implemented at higher levels. The contribution level varied from 5% to 10% of total Basic Medical Insurance (BMI) funds or CNY10‐35 per beneficiary in 2015. IPCD provides an additional 50% to 70% reimbursement rate for the expenses not covered by BMI with various settings in different locations. Two models of CIC operation of IPCD have been identified according to the financial risks shared by CICs. Either the local department of Human Resources and Social Security or a third party performs assessments of the IPCD operation, service quality, and patients' satisfaction. A number of IPCDs have been observed to use 1% to 5% of the funds as a performance‐based payment to the CIC(s). CIC involvement in operating the IPCD raises concerns regarding the security of the information of beneficiaries. Developing appropriate data sharing mechanisms between the local department of Human Resources and Social Security and CICs is still in progress. In conclusion, the IPCD relieves the financial burden on patients by providing further reimbursement, but its benefit package remains limited to the BMI reimbursable list. CICs play an important role in monitoring and supervising health service provision, yet their capacity for actuarial services or risk control is underdeveloped.