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Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China.

ABSTRACT: OBJECTIVES:This study investigates the disparities in the utilisation of patient health services for patients who had a stroke covered by different urban basic health insurance schemes in China. DESIGN:We conducted descriptive analysis based on a 5% random sample from claims data of China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) in 2015, supplied by the China Health Insurance Research Association. SETTING:Chinese urban social insurance system. PARTICIPANTS:A total of 56 485 patients who had a stroke were identified, including 36 487 UEBMI patients and 19 998 URBMI patients. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome measures include annual number of hospitalisations, average length of stay (ALOS) and average hospitalisation cost. Out-of-pocket (OOP) cost is the secondary outcome measure. RESULTS:The annual mean number of hospitalisations of UEBMI patients was 1.21 and 1.15 for URBMI patients. The ALOS was significantly longer for UEBMI than for URBMI patients (13.93 vs 10.82, p<0.001). Hospital costs were significantly higher for UEBMI than for URBMI patients (US$1724.02 vs US$986.59 (p<0.001), while the OOP costs were significantly higher for URBMI than for UEBMI patients (US$423.17 vs US$407.81 (p<0.001). Patients with UEBMI had higher reimbursement rate than URBMI patients (79.41% vs 66.92%, p<0.001) and a lower self-paid ratio than URBMI patients (23.65% vs 42.89%, p<0.001). CONCLUSIONS:Significant disparities were found in the utilisation of hospital services between UEBMI and URBMI patients. Our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gaps in China's health insurance schemes.

SUBMITTER: Yang Y

PROVIDER: S-EPMC7549448 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China.

Yang Yong Y Man Xiaowei X Nicholas Stephen S Li Shuo S Bai Qian Q Huang Lieyu L Ma Yong Y Shi Xuefeng X

BMJ open 20201010 10

<h4>Objectives</h4>This study investigates the disparities in the utilisation of patient health services for patients who had a stroke covered by different urban basic health insurance schemes in China.<h4>Design</h4>We conducted descriptive analysis based on a 5% random sample from claims data of China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) in 2015, supplied by the China Health Insurance Research Association.<h4>Setting</h4>Chinese ...[more]

PMID: 33040017

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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.

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Dataset Information

Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China.

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Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China.

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