Who benefits the most from basic health insurances? Income-related equity analysis for patients with chronic diseases in China

Abstract

BackgroundTo relieve patients' financial burden, China has established three basic health insurances: Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and the New Rural Cooperative Medical Scheme (NRCMS). However, because the insured rich have more opportunity to access health care, more subsidies might be paid to them rather than the poor. We analysed the income-related benefit equity of health insurance for patients with chronic diseases to investigate who benefits most from government health insurance in China. MethodsWe used data from the second phase of the China Health and Retirement Longitudinal Study (CHARLS), collected in 2013. Benefit incidence (use of inpatient care or not), benefit degree 1 (measured by subsidy paid by the basic health insurances for inpatients), and benefit degree 2 (measured by reimbursement paid by health insurances for all patients with chronic diseases, such as cancer, hypertension, and diabetes) were deployed to indicate the benefits from the health insurances. We used the decomposition of the concentration index to analyse income-related horizontal inequity of benefit incidence and benefit degree. FindingsThere were 9728 patients identified for the analysis. The benefit incidence for patients with chronic diseases were 15·42% for those covered by UEBMI, 11·99% for those covered by URBMI, and 12·73% for those covered by NRCMS, while the subsidies paid by the three health insurances for inpatients (benefit degree 1) were ¥6457, ¥3127, and ¥2718, respectively, and for patients with chronic diseases (benefit degree 2) were ¥860, ¥307, and ¥279, respectively. By decomposing the concentration index, the income-related horizontal inequities of benefit incidence were 0·0868 for UEBMI, 0·1904 for URBMI, and 0·1495 for NRCMS. The horizontal inequities of benefit degree 1 and benefit degree 2 were 0·1880 and 0·4194 for UEBMI, 0·1186 and 0·3764 for URBMI, and 0·0900 and 0·2862 for NRCMS. InterpretationWith same health-care needs, high-income patients with chronic diseases benefit more than low-income patients in each of China's basic health insurances. Improvement of benefit equity should be a concern of health insurance policy development. FundingResearch Program of Shaanxi Soft Science (2015KRM117), Shaanxi Provincial Youth Star of Science and Technology in 2016, Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007), National Program for Support of Top-Notch Young Professionals, China Medical Board (15-227).