Abstract
BackgroundThe fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China.MethodsThe data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization.ResultsThe integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011.ConclusionsThe findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.
Highlights
Universal health coverage (UHC) is defined as “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access” by the 2005 World Health Assembly [1]
About 2.1% of the mid-aged and elderly were covered by government medical insurance (GMI), and 0.9% were not covered by any kinds of health insurance schemes [7]
We find that the integration of New Rural Cooperative Medical Schemes (NRCMS) and Urban Residents Basic Medical Insurance (URBMI) increased the frequency of health care utilization in the integration group
Summary
Universal health coverage (UHC) is defined as “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access” by the 2005 World Health Assembly [1]. As a financial mechanism for UHC and health system, is widely used to promote equal access to health care utilization and financial protection worldwide [2,3,4]. The expansion of social health insurance coverage is widely considered as the important step towards achieving the goal of UHC that caters for everyone by providing access to adequate health services at an affordable price [5]. To move toward UHC, the Chinese government has launched comprehensive social health insurance schemes since 1998. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes.
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