An Empirical Study on the Benefits Equity of the Medical Security Policy: the China Health and Nutrition Survey (CHNS).

Huan Liu,Weidong Dai

doi:10.3390/ijerph17041203

Abstract

Background: One of the fundamental objectives of the basic medical security system is to provide institutional guarantees for the appropriate medical needs of different groups. Among them, achieving fairness of benefits is the first principle of the system. This study aims to explore the benefit equity of preventive health care for different groups and the specific path to promote fairness. Methods: Based on the 2015 CHNS survey data, through the theory construction of benefit fairness in the basic medical insurance and using the two-stage IV-Heckman model, the paper analyzes the benefit fairness of the basic medical insurance in urban and rural China. Results: This study indicates that (1) the results of empirical and theoretical models are not consistent with the sample of the insured population. (2) As private medical insurance and medical assistance are restricted in the model, the reimbursement ratio of medical insurance in other income groups is all higher than the highest one. However, the coefficient is getting larger, with the lowest income group having the largest coefficient. After controlling for variables of disease and severity, the results suggest that the main impact path is hospitalization costs. (3) Taking the highest income group as a reference, the compensation proportion of preventive health care in other groups is higher, respectively, than the reference group, while the groups below middle income have a significant relationship with compensation for preventive health care. Conclusions: Supplementary private medical insurance and medical assistance have important protection functions for low- and middle-income populations. However, owing to the actual income threshold, the two groups cannot benefit from the medical security system. This result is still valid in the field of preventive health care. The increase of preventive health care expenditure reduces the cost of individual hospitalization, but the high-income group has emerged with more preventive health care expenditures, creating new unfairness.

Highlights

One of the fundamental objectives of the basic medical security system is to provide institutional guarantees for the appropriate medical needs of different groups
The increase of preventive health care expenditure reduces the cost of individual hospitalization, but the high-income group has emerged with more preventive health care expenditures, creating new unfairness
To further explore the fairness of medical compensation for different income groups, we introduce the total cost of hospitalization in the model and use it as the main impact fairness indicator of medical compensation

Summary

Introduction

One of the fundamental objectives of the basic medical security system is to provide institutional guarantees for the appropriate medical needs of different groups. This study aims to explore the benefit equity of preventive health care for different groups and the specific path to promote fairness. Based on the worldwide development process of the basic medical insurance system, the original intention of the system is to effectively fulfill the fundamental medical needs of every citizen. In the process of basic medical insurance reform, adhering to basic fairness is always the ultimate criterion for all counter attempts and a critical indicator to evaluate the success or failure of medical reform [1]. This study designs an equalization system for the payment and compensation mechanism of basic medical insurance and focuses on the fairness of the system guarantee to different income groups under equalization. Public Health 2020, 17, 1203; doi:10.3390/ijerph17041203 www.mdpi.com/journal/ijerph

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