The current national health insurance system consists of two parts, compulsory health insurance (CHI) and voluntary health insurance (VHI).
CHI formally consists of two sub-schemes:
- (1) Contributory scheme: Earnings-related, contribution-based Social Health Insurance (SHI) scheme for the formally employed, pensioners, full-time students
- (2) Non-contributory scheme: A non-contributory program for the poor, children under the age of 6, full-time students and some socially protected population groups, such as people of merit, the elderly, and war dioxin victims.
The voluntary scheme (VHI) targets family members of the compulsorily-insured and others who enrolled through group organizations, including communes. Since January 1, 2010, full-time students are also covered by the compulsory program.
HCFP offers a comprehensive benefits package that includes both inpatient and outpatient care. Excluded are interventions covered by vertical programs such as HIV/AIDS prevention and treatment, treatments not yet approved by the MoH, various “luxury” interventions such as cosmetic surgery, certain dental procedures, and treatment of self-inflicted injuries and drug addiction, among others.
HCFP uses government revenues to finance health care for the poor, ethnic minorities living in selected mountainous provinces designated as difficult, and all households living in communes officially designated as highly disadvantaged. The central government finances the bulk of the cost, but provincial governments are responsible for co-financing a percentage of the program. The HCFP had been implemented as a separate social program since 2005. However, since July 2009, the program became a part of the national compulsory insurance scheme (CHI) as a result of the new National Health Insurance Law of July 2009
It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance.
Note that when the insurance program was initially introduced, there was no cost sharing. In 1998, cost sharing was introduced, with a 20 percent coinsurance rate but no deductible. In 2005, the 20 percent coinsurance rate was eliminated, only to be reintroduced again since January 1, 2010. Copayment is exempted for some groups, such as people of merit.
