Comparison of Chinese inpatients with different types of medical insurance before and after the 2009 healthcare reform

Shan Wang,Jianchao Liu,Lin Li,Lihua Liu

doi:10.1186/1472-6963-14-443

Abstract

BackgroundSince 1994, China has established three major basic medical insurance (MI) schemes that aim to provide greater financial protection to members. The 2009 Chinese medical reform emphasized the enhancement of basic medical insurance. This study aims to investigate changes in hospital services costs for inpatients with different types of MI before and after the new Chinese medical reform.MethodsA total of 532,120 inpatient medical records, completed by 11 different hospitals nationwide in 2008 and 2011, were collected from the Ministry of Health retrospectively. Median and mean values were calculated to describe costs and average length of stay, respectively. A chi-square test was used to compare the distribution of patient visits. Wilcoxon rank-sum tests were conducted to compare costs.ResultsThe number of patients hospitalized increased. The average cost per stay in the three basic MI schemes increased, while out-of-pocket (OOP) spending decreased (P < 0.0001). The average cost per day showed similar trends. The purchase of Western medication accounted for the largest proportion of costs in all MI schemes in both years; however, these ratios decreased from 2008 to 2011, while those for other social insurance and OOP patients almost doubled. The average length of stay remained unchanged, and the average lengths of stay in the MI schemes differed before and after the healthcare reform.ConclusionsHealthcare reform with multipartite policies may make interactional impacts on hospitalization services for patients enrolled in MI schemes.

Highlights

Since 1994, China has established three major basic medical insurance (MI) schemes that aim to provide greater financial protection to members
The insurance was categorized into three main types of scheme: Urban Employee’s Basic Medical Insurance (UEBMI) for urban employees underwent a trial run in 1994, was officially issued in 1998, and aimed to provide MI for the urban working population; the New Rural Cooperative Medical System (NCMS), which was officially implemented in 2003, was a voluntary system intended to provide financial subsidies for rural residents’ MI; and Urban Resident Basic Medical Insurance (URBMI), which was established in 2007 and aimed to cover urban residents who were not employed [3]
Discrepancies were observed according to MI scheme type

Summary

Introduction

Since 1994, China has established three major basic medical insurance (MI) schemes that aim to provide greater financial protection to members. Affected by the economic system reforms in the 1970s, the Chinese medical care system was once criticized for a massive reduction in MI coverage, substantial increases in residents’ out-of-pocket (OOP) expenses, and a lack of fairness caused by the increasing gap between urban and rural areas and growing national health expenditure [1]. Facing these challenges, the government prepared new guidelines for healthcare reform in 2006 and officially launched them in 2009. In the development period following their establishment, these basic MI schemes continued to expand their coverage areas, and levels of protection were constantly improved

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