Dataset Information

The effects of China's urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province.

ABSTRACT:

Introduction

In order to alleviate the problem of "Kan Bing Nan, Kan Bing Gui" (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China.

Methods

Using the data from the fourth National Health Services Survey in Shaanxi Province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents.

Results

For the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively.

Conclusions

The implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation.

SUBMITTER: Zhou Z

PROVIDER: S-EPMC4016277 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Publications

The effects of China's urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province.

Zhou Zhongliang Z Zhu Liang L Zhou Zhiying Z Li Zhengya Z Gao Jianmin J Chen Gang G

International journal for equity in health 20140309

<h4>Introduction</h4>In order to alleviate the problem of "Kan Bing Nan, Kan Bing Gui" (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisat ...[more]

PMID: 24606592

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Project description:BackgroundMany countries and regions worldwide are improving their healthcare systems through the integration and unification of health insurance programs covering different groups of people. In China, the past 10 years has been the time when Chinese government promote the Urban and Rural Residents Basic Medical Insurance (URRBMI) by integrating the Urban Residents' Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS).ObjectivesTo evaluate the impact of the URRBMI on equity in relation to health services.MethodsThe quantitative data used in this study were obtained from the CFPS 2014-2020 database, and all respondents with health insurance type UEBMI, URBMI, and NRCMS were included. UEBMI respondents were set as the control group and URBMI or NRCMS as the intervention group, and a DID method model was used to analyze the impact of integrating health insurance on health service utilization, costs and health status. Heterogeneity analysis was also conducted after stratifying the sample according to income level and chronic disease status. This was done to investigate whether there were differences in the effects of the integrated health insurance program across different social groups.ResultsThe implementation of URRBMI is found to be associated with a significant increase in inpatient service utilization (OR = 1.51, P < 0.01) among rural Chinese residents. Regression results by income stratum show that the utilization of inpatient services increased in rural areas for high-, middle- and low-income groups, with the fastest increase (OR = 1.78, P < 0.05) emerging for low-income groups. Analysis by chronic disease status shows that rural residents with chronic disease are associated with a higher increase in hospitalization rates (OR = 1.64, P < 0.01).ConclusionThe implementation of URRBMI is found to have improved health insurance's ability to withstand risks and effectively improve access to health services for rural residents. In this regard, it can be considered as playing a positive role in bridging the gap in health service utilization between rural and urban areas and in improving regional equity.

Project description:BackgroundContinuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China's 2009 healthcare reform on improving the CMHS utilisation.MethodsThis population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China's 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation.ResultsThis study showed post-reform CMHS utilisation was higher in both rural and urban women than the CMHS utilisation pre-reform (according to China's policy defining CMHS). The rate of CMHS utilisation increased from 24.66 to 41.55% for urban women and from 18.31 to 50.49% for rural women (urban: χ2 = 20.64, P < 0.001; rural: χ2 = 131.38, P < 0.001). This finding is consistent when the WHO's definition of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ2 = 10.99, P = 0.001); for urban women, CMHS utilisation increased from 15.70 to 20.56% (χ2 = 2.57, P = 0.109). The GLMM showed that the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR = 5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR = 14.70, 95%CL: 5.43, 39.76). The concentration index for urban women decreased from 0.130 pre-reform (95%CI: - 0.026, 0.411) to - 0.041 post-reform (95%CI: - 0.096, 0.007); it decreased from 0.104 (95%CI: - 0.012, 0.222) to 0.019 (95%CI: - 0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to - 0.047 urban and 0.111 to 0.019 for rural).ConclusionsChina's 2009 healthcare reform has positively influenced utilisation rates and equity of CMHS's utilisation among both urban and rural women in Shaanxi Province. Addressing economic and educational attainment gaps between the rich and the poor may be effective ways to improve the persistent health inequities for rural women.

Project description:BackgroundIn 2016, the Chinese government introduced an integration reform of the health insurance system with the aim to enhance equity in healthcare coverage and reduce disparities between urban and rural sectors. The gradual introduction of the policy integrating urban and rural medical insurance in pilot cities provides an opportunity to evaluate the policy impact. This study attempts to assess the policy impact of urban-rural health insurance integration on the chronic poverty of rural residents and to analyze the mechanisms.MethodBased on the four waves of data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018, we employed a staggered difference-in-differences (staggered DID) model to assess the impact of integrating urban-rural health insurance on poverty vulnerability among rural inhabitants and a mediation model to analyze the mechanism channel of the policy impact.Results(1) Baseline regression analysis revealed that the urban-rural health insurance integration significantly reduced the poverty vulnerability of rural residents by 6.32% (p < 0.01). The one health insurance system with one unified scheme of contributions and benefits package (OSOS, 6.27%, p < 0.01) is more effective than the transitional one health insurance system with multiple schemes (OSMS, 3.25%, p < 0.01). (2) The heterogeneity analysis results showed that the urban-rural health insurance integration had a more significant impact on vulnerable groups with relatively poor health (7.84%, p < 0.1) than those with fairly good health (6.07%, p < 0.01), and it also significantly reduced the poverty vulnerability of the group with chronic diseases by 9.59% (p < 0.01). The integration policy can significantly reduce the poverty vulnerability of the low consumption and low medical expenditure groups by 8.6% (p < 0.01) and 7.64% (p < 0.01), respectively, compared to their counterparts. (3) The mechanism analysis results showed that the urban-rural health insurance integration can partially enhance labor supply (14.23%, p < 0.01) and physical examinations (6.28%, p < 0.01). The indirect effects of labor supply and physical examination in reducing poverty vulnerability are 0.14%, 0.13% respectively.ConclusionThe urban-rural health insurance integration policy significantly reduced poverty vulnerability, and the OSOS is more effective than the OSMS. The urban-rural health insurance integration policy can significantly reduce poverty vulnerability for low consumption and poor health groups. Labor supply and physical examination are indirect channels of the impact. Both channels potentially increase rural household income and expectations of investment in human health capital to achieve the policy objective of eliminating chronic poverty.

Project description:BackgroundEnsuring access to essential quality health services and reducing financial hardship for all individuals regardless of their ability to pay are the main goals of universal health coverage. Various health insurance schemes have been recently implemented in low- and middle-income countries (LMICs) to achieve both of these objectives. We systematically reviewed all available literature to assess the extent to which current health insurance schemes truly reach the poor and underserved populations in LMICs.MethodsIn the systematic review, we searched on PubMed, Web of Science, EconLit and Google Scholar to identify eligible studies which captured health insurance enrollment information in LMICs from 2010 up to September 2019. Two authors independently selected studies, extracted data, and appraised included studies. The primary outcome of interest was health insurance enrollment of the most vulnerable populations relative to enrollment of the best-off subgroups. We classified households both with respect to their highest educational attainment and their relative wealth and used random-effects meta-analysis to estimate average enrollment gaps.Results48 studies from 17 countries met the inclusion criteria. The average enrollment rate into health insurance schemes for vulnerable populations was 36% with an inter-quartile range of 26%. On average, across countries, households from the wealthiest subgroup had 61% higher odds (95% CI: 1.49 to 1.73) of insurance enrollment than households in the poorest group in the same country. Similarly, the most educated groups had 64% (95% CI: 1.32 to 1.95) higher odds of enrollment than the least educated groups.ConclusionThe results of this study show that despite major efforts by governments, health insurance schemes in low-and middle-income countries are generally not reaching the targeted underserved populations and predominantly supporting better-off population groups. Current health insurance designs should be carefully scrutinized, and the extent to which health insurance can be used to support the most vulnerable populations carefully re-assessed by countries, which are aiming to use health insurance schemes as means to reach their UHC goals. Furthermore, studies exploring best practices to include vulnerable groups in health insurance schemes are needed.RegistrationNot available.

Dataset Information

The effects of China's urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province.

Introduction

Methods

Results

Conclusions

Publications

The effects of China's urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province.

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