Abstract
BackgroundUrban population in China is mainly covered by two medical insurance schemes: the Urban Employee Basic Medical Insurance (UEBMI) for urban employees in formal sector and the Urban Resident Basic Medical Insurance (URBMI) for the left urban residents, mainly the unemployed, the elderly and children. This paper studies the effects of UEBMI and URBMI on health services utilisation in Shaanxi Province, Western China.MethodsCross-sectional data from the 4th National Health Services Survey - Shaanxi Province was studied. The propensity score matching and the coarsened exact matching methods have been used to estimate the average medical insurance effect on the insured.ResultsCompared to the uninsured, robust results suggest that UEBMI had significantly increased the outpatient health services utilisation in the last two weeks (p<0.10), whilst the significant effect on hospitalisation was evident in the CEM method (p<0.10). The effect of URBMI was limited in that although being insured was associated with higher health services utilisation, compared with the uninsured, none of the improvement was statistically significant (p>0.10). It was also found that compared with the uninsured, basic medical insurance enrollees were more likely to purchase inpatient treatments in lower levels of hospitals, consistent with the incentive of the benefit package design.ConclusionBasic Medical insurance schemes have shown a positive but limited effect on increasing health services utilisation in Shaanxi Province. The benefit package design of higher reimbursement rates for lower level hospitals has induced the insured to use medical services in lower level hospitals for inpatient services.
Highlights
Before China commenced its economic reform from a centralised economy to a market-driven one in the late 1970s, there was near-universal insurance coverage for both rural and urban populations [1,2]: the Cooperative Medical System (CMS) for the rural population; the Government Insurance Scheme (GIS) for government employees, retirees, disabled veterans, university teachers and students; and the Labor Insurance Scheme (LIS) for company employees, their dependents, and retirees
The government and enterprises struggled with the immense financial burden of these two systems, driving the pilot experiments of Medical Savings Accounts (MSAs) in 1994, which latterly expanded to a new city-based social health insurance scheme covering the whole country in 1998, named Urban Employee Basic Medical Insurance (UEBMI) [4,5]
The aim of this study is to investigate the effect of two basic medical insurance schemes on health services utilisation in Shaanxi Province, western China
Summary
Before China commenced its economic reform from a centralised economy to a market-driven one in the late 1970s, there was near-universal insurance coverage for both rural and urban populations [1,2]: the Cooperative Medical System (CMS) for the rural population; the Government Insurance Scheme (GIS) for government employees, retirees, disabled veterans, university teachers and students; and the Labor Insurance Scheme (LIS) for company employees, their dependents, and retirees. The rapid escalation of health care costs in urban China led in part to a fiscal crisis in both the GIS and the LIS; as a result workers were in effect uninsured [4]. Urban population in China is mainly covered by two medical insurance schemes: the Urban Employee Basic Medical Insurance (UEBMI) for urban employees in formal sector and the Urban Resident Basic Medical Insurance (URBMI) for the left urban residents, mainly the unemployed, the elderly and children. This paper studies the effects of UEBMI and URBMI on health services utilisation in Shaanxi Province, Western China
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