OBJECTIVES : To analyze the trend of annual medical expenditure and individual medical burden among the Basic Medical Insurance (BMI) Participants in China in 2015-2017, and determine whether the BMI payment policies are appropriate for the insured persons.

METHODS : This study use the data of 34 cities from the National Medical Service Utilization Sample Survey for the BMI Participants in 2015-2017. The total sample cases were about 3043 thousands. Descriptive and comparative analysis was applied to the data and related BMI payment policies were reviewed.

RESULTS : 1) Altogether there were 175.56 million insured persons who used medical services in 2017, among which 96.32% used outpatient medical services and 12.40% used inpatient medical services. 2) Most of the patients went to high-level hospitals to see doctors. 36.83% went to the third level hospitals and 18.71% went to the secondary level hospitals. 3) Averagely every 45 outpatient visits may result in 1 hospitalization. 4) The average annual medical expenditure increased from 2415 RMB in 2015 to 3661 RMB in 2016 for BMI participants, among which 1399 RMB (38%) was paid out-of-pocket. 5) The medical burden from hospitalization (42.06%) was higher than that from outpatient services. 6) The amount of total burden of employee participants (4535 RMB) was 1.6 times higher than that of urban residents, but the proportion of out-of-pocket (34.57%) was lower than the latter.

CONCLUSIONS : Grading diagnosis and treatment should be promoted to guide the patients with commonly encountered diseases to be treated in basic level hospitals, which will control the irrational increase of medical expense and alleviate the total medical burden. At the same time, the medical service supervision should be enhanced to improve the rationality of medical services and decrease the unnecessary expenditures.