Social health insurance, healthcare utilization, and costs in middle-aged and elderly community-dwelling adults in China

Zhonghua Wang,Mingsheng Chen,Xiangjun Li,Lei Si

doi:10.1186/s12939-018-0733-0

Abstract

BackgroundAlthough many studies have analyzed health insurance worldwide, most focus on whole populations rather than specific vulnerable groups. There is a lack of studies that compare different schemes. This paper evaluates the impact of different types of social health insurance and other associated factors on healthcare utilization and costs among middle-aged and elderly Chinese adults.MethodsData were obtained from a nationally representative middle-aged and elderly household survey, the China Health and Retirement Longitudinal Study, which was conducted in 2015. Middle-aged and elderly are defined as people who are ≥45 years. Descriptive statistics were used to show the prevalence of each variable. Both logistic and multiple linear regression models were used to evaluate the association between healthcare utilization/healthcare costs and health insurance in addition to other related factors.ResultsAlthough the rapid expansion of social health insurance coverage has significantly improved the healthcare utilization among middle-aged and elderly adults, the difference between three schemes is large. Urban Employee Medical Insurance (UEMI) has had a greater effect in improving healthcare utilization than New Cooperative Medical Insurance (NCMI) or Urban Resident Medical Insurance (URMI). Unification of health insurance programs and optimization of health resource allocations should be a practical way to alleviate healthcare utilization inequality across schemes. People having social health insurance spend more on total and out-of-pocket (OOP) healthcare costs than people not covered by social health insurance, suggesting that enrollment in social health insurance induces significant increases in both total and OOP healthcare expenses. UEMI for the urban employed has relatively higher funding criteria and reimbursement rate, which makes the greatest extent to induce increase in healthcare costs. Some demographic or socioeconomic factors significantly affect healthcare utilization and costs among middle-aged and elderly adults.ConclusionOur study demonstrates the differences in healthcare utilization and costs between those with and without social health insurance and between those with different health insurance schemes. Policy efforts should further focus on adjusting social health insurance and optimizing healthcare resource allocation in order to enhance effective utilization of healthcare services and control cost increases among middle-aged and elderly adults.

Highlights

Many studies have analyzed health insurance worldwide, most focus on whole populations rather than specific vulnerable groups
This proportion was highest among the middleaged and elderly population not covered by social health insurance (43%), second highest among people with Urban Resident Medical Insurance (URMI) (41%), and lowest among people covered by New Cooperative Medical Insurance (NCMI) (28%)
The proportion of individuals perceiving a need for inpatient care but not undergoing hospitalization during the past year was approximately 21%, and it was highest among people not covered by social health insurance (33%)

Summary

Introduction

Many studies have analyzed health insurance worldwide, most focus on whole populations rather than specific vulnerable groups. There are mainly three types of social health insurance schemes in China: 1) Urban Employee Medical Insurance (UEMI); 2) Urban Resident Medical Insurance (URMI); and 3) New Cooperative Medical Insurance (NCMI). The NCMI for rural residents and the URMI covering urban residents who had no formal employment were introduced in 2003 and 2007, respectively. These three schemes covered > 95% of the population (about 1.336 billion people) by the end of 2015 [4]. Healthcare utilization and costs are still very unequal across different sub-populations, and rapid expansion of social health insurance has not reached the universal level of generosity seen in other countries [5]

Methods

Results

Conclusion