Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009

Jinan Liu,M Mahmud Khan,Lizheng Shi,Qingyue Meng

doi:10.1186/1475-9276-11-42

Abstract

IntroductionChina introduced the urban resident basic medical insurance (URBMI) in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS) for rural residents in 2003 and the basic health insurance scheme (BHIS) for urban employees in 1998. This study examined whether the overall income-related inequality in health insurance coverage improved during 2006 and 2009 in China.MethodsThe China Health and Nutrition Survey (CHNS) data of 2006 and 2009 were used to create the concentration curve and the concentration index. GEE logistic regression was used to model the health insurance coverage as dependent variable and household income per capita as independent variable, controlling for individuals' age, gender, marital status, educational attainment, employment status, year 2009 (Y2009), household size, retirement status, and geographic variations. The change in the income-related inequality in 2009 was estimated using the interaction term of income*Y2009.ResultsIn 2006, 49.7% (4,712/9,476) respondents had health insurance: 13.4% with BHIS and 28.4% with NCMS. In 2009, 90.8% (8,964/9,863) had health insurance: 10.1% with URBMI, 18.3% with BHIS, and 57.6% with NCMS. The BHIS, URBMI, and NCMS programs had different patterns of population coverage over 10 income deciles. The concentration index was 0.15 in 2006 and 0.04 in 2009. The dominance test showed that the concentration curves were significantly different between 2006 and 2009 (p < 0.05). An income increase per capita by 10,000 RMB was associated with 25.5% more likely to have health insurance coverage (odds ratio = 1.255, 95% confidence interval: [1.130-1.393]). In 2009, there was significant improvement in the income-related inequality (p < 0.001).DiscussionsComparing 2009 to 2006, the income inequality in health insurance coverage was largely corrected in China through rapid expansion of CHNS in rural areas and initiation of URBMI in urban areas.

Highlights

China introduced the urban resident basic medical insurance (URBMI) in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS) for rural residents in 2003 and the basic health insurance scheme (BHIS) for urban employees in 1998
Despite very rapid growth of the economy during the last decade of the 20th century, the health sector of China remained relatively disorganized and health insurance coverage of the population declined over the years [1]
Local governments are responsible for the management of the BHIS

Summary

Introduction

China introduced the urban resident basic medical insurance (URBMI) in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS) for rural residents in 2003 and the basic health insurance scheme (BHIS) for urban employees in 1998. Despite very rapid growth of the economy during the last decade of the 20th century, the health sector of China remained relatively disorganized and health insurance coverage of the population declined over the years [1]. To improve health insurance coverage in China, the urban employee Basic Health Insurance Scheme (BHIS) was introduced in urban China in December of 1998. This program, which provides coverage to the employees and retirees in the public sector, remains limited in population coverage [3,4]. Health insurance coverage remained low in both rural and urban areas even in 2003. By 2003, only 22% of people in urban areas and 13% in rural areas had some forms of health insurance [5]

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