关于中国医保运行机制及其变化，你应该知道的_OK阅读网
双语新闻
Bilingual News

双语对照阅读
分级系列阅读
智能辅助阅读
在线英语学习
首页 |  双语新闻 |  双语读物 |  双语名著 | 
[英文] [中文] [双语对照] [双语交替]    []        


关于中国医保运行机制及其变化，你应该知道的
How Health Insurance Works in China, and How It’s Changing

来源：纽约时报    2023-02-24 12:11



        Almost everyone in China has had at least some health insurance since new policies were introduced a decade ago. Now China has begun pursuing a second wave of changes.        自从十年前相关新政策出台后，几乎每个中国人都或多或少拥有一定程度的医疗保险。现在，中国开始推行第二波改革措施。
        The new policies, which have triggered protests in several big cities like Wuhan, are aimed at covering deficits in local employee health insurance plans and reducing inequality between cities and rural areas.        这些新政策的目的是弥补地方职工医保计划的亏空，减少城乡不平等，相关政策在武汉等几个大城市引发了抗议。
        Who has health coverage in China?        在中国，哪些人拥有医保？
        China has two main kinds of health insurance: employee hospitalization insurance and so-called residents insurance.        中国有两种主要的医疗保障制度：职工基本医疗保险及城乡居民基本医疗保险。
        The employee hospitalization insurance is the better of the two and used by a quarter of the country’s population. It covers the urban employees and retirees of state-owned enterprises, as well as the current employees of some private-sector businesses.        职工医保是两者中较好的一种，全国四分之一的人口都在使用。它涵盖了国有企业的城镇职工和退休人员以及一些民营企业的在职职工。
        In contrast to the United States, employee insurance in China is not managed by companies. Instead, a municipal government typically forms an employee insurance pool to cover hospitalization and a few outpatient expenses.        与美国不同，中国的雇员保险不是由公司管理。市政府通常会成立一个医保统筹基金，支付住院和一些门诊费用。
        Companies typically contribute to the pools an amount equal to as much as 9.8 percent of a worker’s salary. Employees do not contribute to the insurance pools themselves.        企业通常向保险基金缴纳相当于员工工资9.8%的金额。职工自己不向保险基金缴费。
        In addition, those who qualify for employee plans typically have what are called personal health accounts. The money in them can be spent on medicine and further outpatient treatments.        此外，有资格参加职工保险计划的人通常都有所谓的个人医保账户。里面的钱可以用来购药和支付进一步的门诊治疗。
        The employee insurance pools currently forward about a third of the money they receive from employers to personal health accounts, and spend the remaining two-thirds on hospitalizations and other expenses. Employees also put about 2 percent of their paychecks into their health accounts until they retire.        目前，职工保险基金将从雇主那里收到的约三分之一的钱转到个人医保账户，剩下的三分之二用于住院治疗和其他费用。员工工资的2%也会存入个人医保账户，直到退休。
        Until this month, Wuhan’s employee insurance plan kept forwarding about $38 each month to personal health accounts even after employees retired and their employers were no longer contributing. Wuhan has just cut those monthly transfers to less than $12, saving money for the overall health plan.        直到本月，即使职工退休，雇主不再缴纳保费，武汉市的职工保险计划仍然每月向个人医保账户转出约260元。武汉刚刚将每月的转移支付削减到80元以下，为整个医保计划节省资金。
        The less fortunate three-quarters of China’s 1.4 billion people have urban or rural residents insurance. Residents insurance is for farmers and migrant workers, as well as for children, who are seldom covered by their parents’ health insurance plans. It is also for the many workers whose private-sector employers are not making contributions for them.        在中国14亿人口中，四分之三的人没有那么幸运，得到的是城乡居民基本医疗保险。居民保险是针对农民和农民工以及儿童的（儿童很少被父母的医疗保险计划覆盖）。它也适用于许多民营部门雇主没有为其缴费的员工。
        Many companies use loopholes or outright evasion to avoid making insurance contributions for their workers. In the past decade, China’s government has been cracking down on companies that flout the rules.        许多公司利用漏洞或者逃避为员工缴纳保险费。在过去十年中，中国政府一直在打击那些无视规定的公司。
        People with residents insurance generally do not get personal health accounts.        持居民保险的人一般没有个人健康账户。
        Less than 4 percent of China’s population has no health insurance at all. This portion tends to be migrant gig workers who live at the fringes of society.        中国只有不到4%的人口缺乏任何医疗保险。这部分人往往是生活在社会边缘的农民工。
        How much is covered?        保险范围有多大？
        Not much.        并不大。
        Chinese health insurance plans have narrow restrictions on what is covered, high co-payments and very low coverage maximums. Employee insurance paid out an average of $544 in 2020 for each person covered. Residents insurance paid out an average of just $116 in 2020 for each person covered.        中国的医疗保险计划的承保范围很窄，自付金额很高，最高承保额非常低。2020年，职工保险平均为每个被保险人支付3760元。2020年，居民保险平均为每个被保险人平均支付800元。
        How did the system run into trouble?        该系统是如何陷入困境的？
        Chinese law says that when a municipality’s pooled employee insurance fund runs a deficit, the city government has to cover the shortfall.        中国法律规定，当一个城市的职工保险统筹基金出现亏空时，市政府必须填补缺口。
        Many of these funds now face deficits. They covered many costs associated with China’s elaborate “zero Covid” campaign for nearly three years, including extensive medical isolation and testing.        现在，许多这样的基金面临赤字。它们用来支付中国近三年复杂的“清零”运动许多相关费用，包括大规模的隔离和检测支出。
        In Wuhan, a city making some of the sharpest insurance changes, the pooled employee fund has faced especially high costs.        武汉的医保改革步子迈得很大，该城在管理职工基金面临的成本尤其高昂。
        What is changing in China’s health care?        中国的医疗正在发生什么变化？
        While the pooled employee funds in many cities are depleted, personal health accounts across China have accumulated more than $130 billion. So the central government wants municipalities to put less money into personal health accounts and redirect some of that money to hospitalization funds.        虽然许多城市的职工统筹基金已经耗尽，但中国各地的个人医保账户已累计超过8988亿元。因此，中央政府希望各城市减少对个人账户的投入，并将部分资金转用于统筹基金。
        At the same time, the employee pooled hospitalization plans are taking responsibility for more outpatient expenses for serious illnesses and covering more purchases of medicine.        与此同时，职工统筹住院计划要承担更多大病门诊费用，并涵盖更多的购药费用。
        The rules on spending money from the personal health accounts are also being changed. Beneficiaries will be allowed to direct money to their parents, spouses and children, including family members who live in rural areas. In villages, an illness like cancer can ruin the finances of an entire family.        个人医保账户的使用规定也在改变。受益人将可以把钱直接给他们的父母、配偶和子女使用，包括居住在农村地区的家庭成员。在农村，癌症这样的疾病可以毁掉全家的财务状况。
        People with personal health accounts are also finding it harder now to use the money for themselves. Retirees must now spend at least $75 out of pocket each year on medicine and outpatient expenses before they can claim partial reimbursement from the employee insurance pools. Workers who are still employed must spend at least $100 of their own money.        拥有个人账户的人现在也发现越来越难动用账户里的钱。现在，退休人员每年必须自掏腰包支付至少500元的药费和门诊费用，然后才能从统筹基金中要求部分报销。在职员工必须至少花费700元自己的钱。
        Average income for urban retirees is about $6,000 a year, not including personal savings. Rural retirees live on far less, but also grow some of their own food.        城市退休人员的平均年收入约为四万元，不含个人储蓄。农村退休人员的生活水平要低得多，但他们自己种植一些食物。
                
   返回首页                  

OK阅读网 版权所有(C)2017 | 联系我们