Abstract
IntroductionIn order to alleviate the problem of “Kan Bing Nan, Kan Bing Gui” (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China.MethodsUsing the data from the fourth National Health Services Survey in Shaanxi Province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents.ResultsFor the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively.ConclusionsThe implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation.
Highlights
In order to alleviate the problem of “Kan Bing Nan, Kan Bing Gui” and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively
This study aims to investigate the effects of UEBMI and URBMI on the equity of both outpatient and inpatient utilisation using cross-sectional household survey data
Since this study focused on the residents aged 15 years or older, the valid sample size is 5072 individuals, of whom 2801 residents were covered by UEBMI, 822 residents covered by URBMI and 1449 did not purchase either of the two insurance schemes
Summary
In order to alleviate the problem of “Kan Bing Nan, Kan Bing Gui” (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. In order to alleviate the problem of “Kan Bing Nan, Kan Bing Gui” (too expensive to see doctors and too difficult to access doctors) and to improve the equity of health service utilisation for urban residents, the Chinese state government established two basic medical insurance schemes: the Urban Employee Basic Medical Insurance scheme (UEBMI) and the Urban Resident Basic Medical Insurance scheme (URBMI), to cover the urban residents in 1999 and 2007, respectively [5,6]. A brief introduction about the UEBMI and URBMI from the sample province is introduced below
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