A report asserts that a portion of Chinese have a bias: the medical welfare in the United States is perfect. Patients go to see a doctor at no cost. In fact, even scheduling a dental visit in America (aka 美国看牙) is not inexpensive without U.S. dental insurance (aka 美国牙医保险). Chinese hospitals and clinics now are seeking to reform in order to provide better medical service. Challenges, of course, exist in the reformation process.

Liu Ye, a partner of a clinic in Hangzhou, who is quite satisfied with the reimbursement ratio of Hangzhou medical insurance, is not too excited about being included in the designated clinics of the national medical insurance. Inclusion in the national medical insurance system has almost become a standard for every clinic in Hangzhou because of the great reimbursement ratio. In such circumstances, Liu Ye has to do as the Romans do to stand on the same starting line with other clinics.

The mandatory inclusion reminds of his abroad experience. His college required every student to purchase international student health insurance (aka 留学生保险). He was satisfied with the benefits of his health insurance in light of HPV vaccine (aka hpv疫苗) coverage and emergency copayment. He was agitated then because the school compelled every graduate to purchase OPT insurance (aka opt 保险) and did not allow him to waive health insurance (aka 替换保险) with an alternative equivalent, lower-priced insurance from a third party in the market.

However, his expectations for inclusion in the national medical insurance are not great if he has a choice.

“It is not necessarily a good thing to be included in the national medical insurance system. Clinics sometimes lose money because of it.” Liu Ye gave an example, if the prices of drugs bought by clinics from the market exceed the ones specified by the medical insurance system, the clinics will have to sustain losses when selling them to patients.

For this “money loss” phenomenon, Zhu Minglai, the director of the Center for Health Economics and Medical Insurance of Nankai University, explained, “After being admitted to the national medical insurance system, a clinic will be subject to limitations, such as proportion of medicines, drug specification, medical expenses, etc. All of these aspects are clearly specified.” Generally, the clinics’ independent pricing power will be relatively limited.

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