The reform of the medical welfare system and health equity for the elderly in China: a study in Zhejiang

Xiaoting Liu,Hung Wong

doi:10.1186/s40711-016-0027-0

Abstract

Health equity is the basic theory of universal health insurance and the objective of reform of the medical welfare system. Based on health equity theory with the perspective of giving priority to disadvantaged groups, this article takes Zhejiang province as an example and adopts a mixed-method approach to explore the effects of the reform of the medical welfare system on health equity for older people. The structural equation model (SEM)-based nonrecursive path analysis demonstrates an improvement of health equity for insured elders of the Basic Medical Insurance for Employees (BMIE) and the Urban Basic Medical Insurance for Residents (UBMIR) as a result of an increased utilization of healthcare. However, there is little difference in terms of the utilization of healthcare and health outcomes between old people insured by the New Rural Cooperative Medical System (NRCMS) and those without medical insurance. This results from the low-level benefits of the insurance policy and defective policy design. A qualitative analysis further discovers the insufficient protection of health equity for several types of vulnerable aged groups in the process of healthcare delivery. Finally, this study advocates the perspective of health equity for vulnerable groups, a transition from emphasizing opportunity equity to stressing outcome equity, and the construction of universal health insurance and long-term care system for the disabled elderly.

Highlights

In 2000, China was ranked fourth from the bottom in the World Health Organization’s (WHO) evaluation of the performance of member states by fairness in financial contributions to their health systems (WHO 2000)
Taking the example of the elderly with higher demand for healthcare, we introduce structural equation model (SEM)-based nonrecursive path analysis to explore the relationships between different medical insurance plans, healthcare utilization, and health outcomes in order to answer the question of whether the increasing use of medical care brought by the extended coverage of medical insurance improved the health outcomes for disadvantaged older people
Path-analysis modeling and estimation This study adopted a structural equation model to set up a nonrecursive path-analysis model, using the exploratory analysis approach of maximum likelihood estimation to examine the associations among different insurance plans, healthcare expenditures, and health status with the help of AMOS 17.0 software

Summary

Introduction

In 2000, China was ranked fourth from the bottom in the World Health Organization’s (WHO) evaluation of the performance of member states by fairness in financial contributions to their health systems (WHO 2000). The argument that “the healthcare system reform basically failed” aroused public opinion and led to a heated debate (Ge and Gong 2007). An important reason leading to the collapse of fairness is the excessive market orientation in the healthcare reform along with the transformation of the economic system, resulting in serious damage to citizens’ health equity. In terms of medical welfare reform, the governments did not take a leading role, and the governments reduced financial support of medical care (Hu and Deng 2008).

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