Medical Insurance Information Systems in China: Mixed Methods Study

Area of Science:

• Health Informatics
• Public Health Policy
• Information Systems Management

Background:

• China's basic medical insurance system (MIS) established in 1998 has seen phased development of its information systems (MIISs).
• National medical security systems integration in 2018 necessitated MIIS reconstruction.
• This study summarizes 20 years of China's medical insurance informatization experience for national and developing country contexts.

Purpose of the Study:

• To analyze historical medical insurance informatization policies in China.
• To assess the current state of provincial MIIS development and policies.
• To provide recommendations for MIIS design during China's MIS reform and for developing nations.

Main Methods:

• Policy analysis of laws, regulations, and documents from 1998-2020.
• Questionnaire survey of 31 provincial medical security bureaus on system aspects.
• Literature review of MIIS-related documents and US Health Insurance Portability and Accountability Act.
• Telephone interviews to validate survey data and identify key issues.

Main Results:

• Networked MIISs exist in 74% of regions, with 65% supporting dual ID/social security card recognition.
• Provincial/municipal MIISs are networked in 55% of regions, collecting basic medical insurance data.
• While functional modules like business operations and reimbursement are common, data security, privacy policies, and in-depth data utilization are lacking.

Conclusions:

• Future MIIS development should be unified across national, provincial, and local levels.
• Strengthen standard codes, data exchange, and utilization, alongside privacy regulations.
• Enhance interconnectivity with other health systems and leverage data for public health monitoring to build stakeholder trust.