Table 1 Comparison of UEBMI and URBMI policies for ESKD patients in Guangzhou city in 2013
| Â | UEBMI | URBMI | |||||
|---|---|---|---|---|---|---|---|
Inception year | 2002 | 2008 | |||||
Eligible population | Urban employed | Urban non-employed | |||||
(Employees; Retirees) | (Children & full-time Students; Unemployed adults; | ||||||
| Â | Elderly residents not covered by the UEBMI scheme) | ||||||
Sources of funding | The employers contribute 6% of the employee’s salary | Government subsidy (70%) and individual premium (30%) | |||||
whilst the employees contribute 2%; | CNY440 to CNY1800 per person per year for residents | ||||||
Retirees are exempted from premium contribution | (including government subsidy) | ||||||
Accounts | Medical Savings Account (including employee | Social Risk-pooling Account (all funds) for inpatient | |||||
contributions and 30% of employer contributions) | care and critical (i.e. chronic or fatal diseases including | ||||||
for outpatient care; Social Risk-pooling Account (70% | ESKD) outpatient care | ||||||
of employer contributions) for inpatient care and | Â | Â | Â | Â | |||
critical (i.e. chronic or fatal diseases including | Â | Â | Â | Â | |||
ESKD) outpatient care | Â | Â | Â | Â | |||
| Â | CRITICAL OUTPATIENT | CRITICAL OUTPATIENT | |||||
Benefit packages of Social Risk-pooling Account | (HD, PD, KT immunosuppression) | (HD, PD, KT immunosuppression) | |||||
Employees | Primary hospitals | 90% | Children & students | Primary hospitals | 85% | ||
Secondary hospitals | 85% | Secondary hospitals | 75% | ||||
Reimbursement ratea (Outpatient care) | Tertiary hospitals | 80% | Tertiary hospitals | 65% | |||
Retirees | Primary hospitals | 93% | Unemployed adults and | Primary hospitals | 85% | ||
Secondary hospitals | 89.5% | Elderly residents | Secondary hospitals | 70% | |||
Tertiary hospitals | 86% | Tertiary hospitals | 55% | ||||
Reimbursed ceiling (Outpatient care) | HD and PD: No monthly ceiling | HD and PD: No monthly ceiling | |||||
KT immunosuppression: CNY6000 monthly | KT immunosuppression: CNY5500–6000 monthly | ||||||
| Â | INPATIENT | INPATIENT | |||||
Deductible: (Inpatient care) | Employees | Primary hospitals | CNY400 | Children & students | Primary hospitals | CNY120 | |
Secondary hospitals | CNY800 | Secondary hospitals | CNY240 | ||||
Tertiary hospitals | CNY1600 | Tertiary hospitals | CNY480 | ||||
Retirees | Primary hospitals | CNY280 | Unemployed adults and | Primary hospitals | CNY280 | ||
Secondary hospitals | CNY560 | Elderly residents | Secondary hospitals | CNY560 | |||
Tertiary hospitals | CNY1120 | Tertiary hospitals | CNY1120 | ||||
Reimbursement ratea (Inpatient care) | Employees | Primary hospitals | 90% | Children & students | Primary hospitals | 85% | |
Secondary hospitals | 85% | Secondary hospitals | 75% | ||||
Tertiary hospitals | 80% | Tertiary hospitals | 65% | ||||
Retirees | Primary hospitals | 93% | Unemployed adults and | Primary hospitals | 75% | ||
Secondary hospitals | 89.5% | Elderly residents | Secondary hospitals | 65% | |||
Tertiary hospitals | 86% | Tertiary hospitals | 55% | ||||
Reimbursed ceiling (Inpatient care) | Six times of local employees’ annual average wage | Six times of local household disposable income | |||||
CNY382,512 | Â | Â | CNY228,324 | Â | Â | ||