Did the Integrated Urban and Rural Resident Basic Medical Insurance Improve Benefit Equity in China?

OBJECTIVES: The reform of merging 2 major health insurance schemes into Urban and Rural Resident Basic Medical Insurance (URRBMI) is recognized as a vital step to safeguard equal healthcare and benefit to each enrollee in China. Against this backdrop, this article aims to evaluate the impact of URRBMI integration on benefit and its contribution to benefit equity. METHODS: The data of this study were derived from the China Health and Retirement Longitudinal Study 2011 and 2015. A total of 11 383 individuals were included in the final sample. Coarsened exact matching with difference-in-difference approach was firstly adopted to investigate the treatment effects of URRBMI on benefits. Next, the decomposition of concentration index (CI) was conducted to explore the contribution of URRBMI to benefit equity. RESULTS: The coarsened exact matching with difference-in-difference results revealed that the consolidation of URRBMI has significantly improved outpatient benefit. The decomposition results showed that the contribution rates of URRBMI scheme to outpatient benefit rate (CI -0.0114), benefit probability (CI 0.0673), compensation fee (CI 0.0076), and reimbursement ratio (CI 0.0483) were 11.26%, -3.38%, -7.67%, and -0.81%, suggesting that this reform makes contribution to the propoor inequity in the outpatient benefit rate and relieves the prorich inequity in outpatient benefit probability and the degree of benefits. CONCLUSIONS: The findings of this study provide novel evidence of enhanced benefits and benefit equity for outpatient care with the integration of URRBMI. Further efforts should be made to the expansion of URRBMI coverage and the elimination of income disparities that affecting benefit equity.

Research on the horizontal equity of inpatient benefits among NCMS enrollees in China: evidence from Shaanxi Province.

BACKGROUND: Equity is an important goal for countries in formulating relevant health policies, and research on the equity of health services is more important for China, where the gap between the rich and poor is widening. The aims of this study are to explore to what extent the benefit equity of New Rural Cooperative Medical System enrollees has been achieved and to determine the geographical disparities in Shaanxi province and thus provide suggestions for future policy formulations. METHODS: Data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. A two-step mode was used to analyse the influencing factors of the inpatient benefit rate and inpatient compensation fee. Concentration indexes and concentration curves were applied to measure the inequity of the inpatient benefit rate and inpatient compensation fee. The decomposition method was employed to explore the source of inequity and horizontal inequity. RESULTS: Based on a sample of 38,032 enrollees, our results showed that there were pro-rich inequities in the inpatient benefit rate and compensation fee. The concentration index of the inpatient benefit rate and compensation fee in 2013 were 0.064 and 0.174, respectively. The economic level (224.62%), self-evaluated health status (- 25.89%) and occupation status (- 12.32%) were the primary three contributors to the inequity of the inpatient benefit rate, and the economic level (106.16%) and age (- 2.88%) were the first two contributors to the inequity of the compensation fee. There were regional differences in the sources of inequities. Moreover, pro-rich horizontal inequity remained after standardizing health care needs. CONCLUSIONS: Our results indicated that there were pro-rich inequities in the inpatient benefit rate and compensation fee in the New Rural Cooperative Medical System. The economic levels of enrollees accounted for most of the existing inequity, followed by self-evaluated health scores and age. Efforts should be made to strengthen policies and programmes in the New Rural Cooperative Medical System to achieve basic health services equity, such as implementing hierarchical medical treatments and reducing extra inpatient benefits for the rich.

Study on hospitalization benefit equity of the basic medical insurance programs in China / 中国卫生政策研究

Objective: To analyze the equity of benefit for inpatient services under the three basic medical insurance programs in China.Methods: Using the baseline survey data collected by China Family Panel Studies (CFPS) in 2010, and the two-part model was applied to explore whether the insured groups with different income levels had different aspects on inpatient rate and the compensation of hospitalization expenses in health insurance coverage.Results: There was no significant difference in the inpatient service utilization rate for different income groups, but the highest and second highest income groups reimburse more expenses than the lowest income group, that is 36.5% and 26.3%, respectively.Specifically, the income level and the compensation amount are not significantly correlated in the Urban Employer Medical Insurance (UEMI) program;the compensation amounts to be paid by urban residents are basically increasing with the increase of the income level;and there is a moderate discrepancy between the highest and the lowest income groups in the New Rural Cooperative Medical System (NCMS).Conclusion: The benefit equity is obviously fair in terms of inpatient service utilization rate, but the benefit degree increases for higher income groups, which shows that there are unfair inequalities related to the income at the level of reimbursement.In terms of program comparison, the benefit degree equity is higher for the UEMI program, followed by the URMI program and the NCMS program is the worst.Besides, the impatient rate and reimbursement amounts are significantly lower for NCMS program participants.The government should merge URMI and NCMS programs, actively promote the integration of basic medical insurance system by strengthening the construction of the medical assistance system and improving the system of catastrophic disease medical expenditure insurance in order to achieve better benefit equity.

Analyzing the Benefit Equity in China’s Basic Health Insurance System / 中国卫生经济

Objective: To analyze the equity of benefit which residents with different income get from Urban Employee Medical Insurance ( UEMI) and New Rural Cooperative Medical System (NCMS). Methods: Data used in this study is based on the forth household health service survey in Shanxi province. The indirectly standardization method and concentration index were employed to analyze the horizontal inequity index of benefit rate and benefit degree. Results:The horizontal inequity index of benefit rate and benefit degree in UEMI are 0.0524 and 0.0025, and the horizontal inequity index of benefit rate and benefit degree in NCMS are 0.2312 and 0.3228. Conclusion: The urban residents get the equal benefit from UEM, and there were pro-rich horizontal inequities of benefit rate and benefit degree in NCMS.