Abstract
BackgroundChina has recently made efforts to integrate urban and rural basic medical insurance systems in order to ensure both urban and rural enrollees obtain unified benefits. However, whether the distribution of government healthcare subsides has become more equitable remains unknown. The purpose of this study was to analyze determinants of and inequality in net inpatient care benefits under the integration of urban-rural medical insurance systems in China.MethodsData were obtained from a nationally representative household survey, the Fifth National Health Services Survey (2013), conducted in Anhui province. A multiple regression model and concentration index (CI) was used to estimate related factors and inequality of inpatient care net benefits.ResultsFindings indicated that individuals received more inpatient care benefits when urban and rural social healthcare systems were integrated. Factors associated with net benefits included gender, age, marital status, retirement, educational level, history of chronic diseases, health status, willingness to seek inpatient care and per capita income. The rich were found to disproportionately benefit from inpatient care, and the CI of net benefits for integrated insurance enrollees was the lowest among all three available health insurance schemes. These findings indicate that the recent unification of urban-rural social health insurances reduces inequality in net benefits from government subsidies. Some socioeconomic factors, such as per capita income, 60 years of age and over, history of chronic disease and high educational level positively influence inequality.ConclusionIn China, accelerating the integration of urban and rural medical insurance systems is an effective way to increase equity of benefit in urban and rural areas. Strategies aimed at reducing inpatient benefit inequality must address socioeconomic factors influencing healthcare outcomes.
Highlights
Achieving universal health coverage(UHC) which provides all individuals and communities with quality health services they need while sparing financial hardship, is one of the important targets of the Sustainable Development Goals set forth by the United Nations in 2015 [1]
76, 45 and 61% of respondents enrolled in New Rural Cooperative Medical Scheme (NRCMS), Urban Resident Basic Medical Insurance (URBMI) and URRBMI were employed, respectively
Individuals enrolled in URBMI demonstrated a significantly higher proportion of at least a high school education level (35%) than did respondents enrolled in NRCMS (10%) or URRBMI (12%). 57% of people enrolled in URRBMI were found to have a low level of education. 7% of individuals enrolled in NRCMS or URRBMI and 9% of people enrolled in URBMI suffered from one or multiple chronic diseases. 72% of URBMI enrollees could access health facilities within 1 kilometer of their residence, a significantly greater percentage than individuals enrolled in NRCMS (47%) or URRBMI (43%)
Summary
Achieving universal health coverage(UHC) which provides all individuals and communities with quality health services they need while sparing financial hardship, is one of the important targets of the Sustainable Development Goals set forth by the United Nations in 2015 [1]. The ultimate goal of social health insurance is to provide affordable, cost-effective, and equitable healthcare for all [2]. Since 2009, the Chinese government has been deepening the health care system reform with the goal of providing affordable and equitable basic health services for citizens [3]. Three programs compose the Chinese social health insurance system These include the Urban Employee Basic Medical Insurance (UEBMI) established in 1998 for individuals employed in the urban sector, the New Rural Cooperative Medical Scheme (NRCMS) launched in 2003 to cover the large.
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