Basic Medical Insurance System Research Articles

Health financing and integration of urban and rural residents\u2019 basic medical insurance systems in China

BackgroundChina is in the process of integrating the new cooperative medical scheme (NCMS) and the urban residents’ basic medical insurance system (URBMI) into the urban and rural residents’ basic medical insurance system (URRBMI). However, how to integrate the financing policies of NCMS and URBMI has not been described in detail. This paper attempts to illustrate the differences between the financing mechanisms of NCMS and URBMI, to analyze financing inequity between urban and rural residents and to identify financing mechanisms for integrating urban and rural residents’ medical insurance systems.MethodsFinancing data for NCMS and URBMI (from 2008 to 2015) was collected from the China health statistics yearbook, the China health and family planning statistics yearbook, the National Handbook of NCMS Information, the China human resources and social security statistics yearbook, and the China social security yearbook. “Ability to pay” was introduced to measure inequity in health financing. Individual contributions to NCMS and URBMI as a function of per capita disposable income was used to analyze equity in health financing between rural and urban residents.ResultsURBMI had a financing mechanism that was similar to that used by NCMS in that public finance accounted for more than three quarters of the pooling funds. The scale of financing for NCMS was less than 5% of the per capita net income of rural residents and less than 2% of the per capita disposable income of urban residents for URBMI. Individual contributions to the NCMS and URBMI funds were less than 1% of their disposable and net incomes. Inequity in health financing between urban and rural residents in China was not improved as expected with the introduction of NCMS and URBMI. The role of the central government and local governments in financing NCMS and URBMI was oscillating in the past decade.ConclusionsThe scale of financing for URRBMI is insufficient for the increasing demands for medical services from the insured. The pooling fund should be increased so that it can better adjust to China’s rapidly aging population and epidemiological transitions as well as protect the insured from poverty due to illness. Individual contributions to the URBMI and NCMS funds were small in terms of contributors’ incomes. The role of the central government and local governments in financing URRBMI was not clearly identified. Individual contributions to the URRBMI fund should be increased to ensure the sustainable development of URRBMI. Compulsory enrollment should be required so that URRBMI improves the social medical insurance system in China.

Age or health status: which influences medical insurance enrollment greater?

BackgroundThe New Cooperative Medical Scheme (NCMS) for peasantries implemented in 2003 and the Urban Resident Basic Medical Insurance (URBMI) for the urban unemployed implemented in 2007 have many similarities. They both apply the financing mode of individual premiums plus government’s subsidies, and the voluntary enrollment. The Chinese government plans to integrate these two systems and build a unified basic medical insurance system for the unemployed in order to achieve the medical equity and increase the general health level. Thus, to analyze the main influencing factors of the enrollment of the urban unemployed and rural residents is very important for improving the system and securing the stability of the system during the transition.MethodsThe study uses data from the China Health and Nutrition Survey (CHNS) and adopts logistic regression models to test which factors influence the enrollment of the URBMI and the NCMS under the background of rather high enrollment rate of Chinese basic medical insurances and strong fiscal support of the Chinese government, especially whether health status or age influences enrollment of these two insurances greater.ResultsThere is indeed some adverse selection in the URBMI and the NCMS. Whether the individual has chronic diseases have significant influence on enrollments of both the urban unemployed and rural residents, while whether the individual got ill in last four weeks just influences enrollments of the urban unemployed. Age influences enrollment greater than health status. The older the insured are, the larger the enrollment rates are.ConclusionBecause of the active support for basic medical insurances of the Chinese government, the enrollment performance of the urban unemployed and rural residents has already changed. When implementing the new policy, the government should pay attention to the willingness to enroll in and the change of enrollment performance of the insured. Therefore, under the policy of voluntary enrollment, every coordinated province and city should enlarge the proportion of young people to insuring group, optimizing the age structure, and the financing proportion of governments and individuals should be measured properly. With the increasing of governments’ subsidies, the proportion of individual’s premiums should also be increased.

A Stuy of Health Care Reform in China in Light of the USA and Canadian Systems

This article describes and examines the newly implemented basic medical insurance system for urban employees in China. The insurance system was built on two distinct concepts, individual providence and social insurance, and was characterized by national government mandates, local government administration, and employer/employee contributions. The study found that the Chinese basic medical insurance program for urban employees was implemented in all major urban areas. About 130 million people were covered under the scheme as of May 2005. The program benefits are limited with relatively low ceilings on reimbursable expenses and high cost sharing from the insured. The procedure for reimbursement is complicated and time consuming. China can learn from the U.S. and Canadian systems in both financing and providing healthcare. The U.S. system arguably supplies the best medical services in terms of quality and accessibility for those who are insured and those who can pay out of pocket. But the huge costs may not work well with China at present. The Canadian system, which is relatively effective, efficient, and equitable, although not as accessible, may fit China better. The study also suggests that the U.S. employer-based healthcare insurance system requires a major overhaul. It puts U.S. companies at a disadvantaged position in the increasingly competitive global marketplace.

Examining children’s health equity under the Chinese basic medical insurance system: A comparison between the United States and Mainland China

Public health insurance for China’s children is analyzed using an equity analysis framework and compared to US public health insurance for low-income children. Four dimensions of comparisons are addressed: fairness of financial support, equal treatment for equal need, equality of access to services, and equality of health outcomes. Secondary data from China and US government statistics were used for the comparisons. Recommendations to strengthen China’s health insurance for children include lower out-of-pocket expenses, standardized data collection and management, qualified nurse practitioners providing rural health care, and explicit coverage requirements.

PMH44 - Antidepressant Usage Patterns Of Patients With Major Depressive Disorder Initiated On Snris Compared With Ssris In Beijing, China

To compare antidepressant usage patterns of patients with major depressive disorder (MDD) who were initiated on selective-norepinephrine-reuptake inhibitors (SNRIs) vs selective-serotonin-reuptake inhibitors (SSRIs) in Beijing. A retrospective analysis was conducted using 10% randomly sampled enrollees’ data from the Beijing Urban Employee Basic Medical Insurance system from July 1, 2011 to December 31, 2013. Patients who were diagnosed with MDD using ICD-10 codes F32/F33, aged ≥18 years with 12-month continuous enrollment, and initiated on an SNRI or SSRI at the index date (the index antidepressant) were included. The first diagnosis date in 2012 was the index date. Patients were excluded if they had comorbid cancer, schizophrenia, or bipolar disorder. Time to index antidepressant discontinuation was evaluated. A Cox proportional hazards model was used to detect the difference between the two groups on treatment persistence with/without the key confounders being adjusted for. A total 4,769 patients who were initiated on an SNRI (410) or SSRI (4,359) at the index date were included. During the 1-year follow-up period, the proportions of patients who discontinued their index antidepressants for SNRI initiators were 29.3%, 71.5%, 84.2% and 90.7% by month 1, 3, 6, and 12, respectively; and for SSRI initiators were 45.0%, 86.1%, 90.8%, and 92.0%, respectively. The time to index antidepressant discontinuation was significantly lower in the patients initiated on SNRIs compared with those on SSRIs (median: 1.56 months for SNRI initiators and 0.96 month for SSRI initiators, hazard ratio [95% confidence interval]: 0.78 [0.70, 0.86], p<0.0001). After adjusting for key confounders, the findings remained consistent. In Beijing China, most patients discontinued their index antidepressants much earlier than those from western countries. Patients who were initiated on SNRIs had better treatment persistence than those initiated on SSRIs. Efforts to improve antidepressant treatment persistence and patient outcomes are strongly recommended.

An Evaluation on Equity in Current Primary Healthcare Reform in China

The objective of the article is to assess equity in recent primary healthcare reform in China. Through a careful examination of the current efforts in promoting equity in access to basic healthcare services between urban and rural populations, we aim to identify problems and provide specific suggestions. The method we used was based on literature review and government reports, as well as case studies of healthcare reform in Hunan province; this article adopts the methods of empirical evaluation combined with normative analysis and interpretation. We have found that the government’s efforts to promote equity in economic and geographical accessibility are currently far from sufficient. The coverage and degree of benefit of basic medical insurance has been improved, yet a big gap still exists among different groups. Grassroots health providers are urgently in need of capability and efficiency building in delivering services. We conclude that the basic medical insurance system should be strengthened in order to narrow the gap between rural and urban residents, and urban employees in particular. Health insurance subsidies and reimbursement rates for rural residents should be further increased. The essential drug system also needs to be improved to ensure openness and transparency.

Preventing Fatal Risk through Outpatient Medical Insurance: Evidence from Urban Employee Basic Medical Insurance System in Xinjiang Uighur Autonomous Region, China

Disease burden from non-communicable diseases（NCDs）has attracted worldwide attention.The 2010World Health Organization Global Status Report on Non-communicable Diseases showed that deaths caused by NCDs exceeded 36 million and accounted for 63%of the total deaths in 2008[1].Moreover,using macroeconomic simulation,the World Economic

Integration Study of Shanghai Basic Medical Insurance System for Urban and Rural Residents

At present, Shanghai has basicallyformed basic medical insurance system consisting of basic medical insurance forurban workers, basic medical insurance for urban residents, the new rural cooperativemedical insurance, which covers urban employed population, the urban working population,rural population. Urban-rural system split and run independently, which is not conduciveto social justice, thus narrow the gap between urban and rural areas and strengthenthe integration of the system. In this paper, through the comparison of Shanghai’sbasic medical insurance for urban residents and new rural cooperative medical insurancein funding criteria and medical benefit level and introducing Jiaxing mode, Chengdumode and Dongguan mode, thus put forward the integration solution of Shanghai’sbasic medical insurance system for urban and rural residents.

The Research on Payment of the Cost of Medical Insurance and Its Development in China

At present, along with the reform of China’s medical insurance system, the mode of payment of costs is evolving. This article introduced the general situation of payment mechanism in urban employee basic medical insurance, basic medical insurance system for urban residents and new rural cooperative medical insurance payment mechanism. It took Jiangsu province as example, separately described the revaluation of 3 medical insurance payment, analysis its result. Finally on this basis, putting forward the ideas for the future of insurance system and its method of payment.

Basic medical insurance for the aged from Zhoupu communities in Shanghai：analysis of satisfaction and influencing factors

Objective To investigate satisfactory degree on basic medical insurance system for the aged and to provide more data for improving insurance policies.Methods A face-to-face questionnaire survey was carried out with 367elderly residents in Zhoupu communities in Shanghai using cluster random sampling method.The survey included social demographic characteristics,medical insurance,chronic disease,health cost,etc.The data were analyzed using descriptive statistical analysis,Chi-square test and multivariate logistic regression analysis by SPSS software.Results Totally 357effective questionnaires were collected,with the effective rate being 97.3%.The overall satisfaction rate of the retired employees was high according to our survey,but the satisfaction rates of urban non-employed residents and land-requisitioned peasants were relatively low(P0.001).Single factor analysis and multiple factor analysis both revealed that income,number of chronic diseases and self-rating health had significant association with satisfaction rate of the participants(P0.05).ConclusionThe basic medical insurance for urban non-employed residents and landless peasants needs to be further improved.

Investigation and analysis of the basic medical security system in Guangxi

Objective To understand the performance of the basic medical security system in Guangxi for decision-making support on the development planning of the system during the 12th FiveYear Plan in Guangxi.Methods Descriptive statistics were made to analyze the annual report data of Guangxi's basic medical security system during 2009 to 2011,regarding the basic medical security for urban workers and that for urban residents,as well as those of the new rural cooperative medical system.Results The survey found that the three basic medical security systems in Guangxi have almost achieved full coverage; the compensation ratio keeps rising as the inpatient expenses of urban residents was up to 62.21％,64.96％ and 66.96％ respectively from 2009 to 2011,and that for urban residents up to 34.26％,39.96％ and 49.68％ respectively; the ratio for those covered by the new rural cooperative medical system has been maintained at 45％ for the three years; the coverage of the systems keeps expanding.Conclusion Recommend to integrate pilots of the three security systems and carry out serious diseases pilot programs; encourage reform of the payment system at institutions at or above county level; reform the risk-pooling of disease management of at primary medical institutions; strengthen the information systems of basic medical insurance system,in an effort to ensure the sound development of the basic medical insurance system. Key words: Guangxi; Basic medical insurance system; Basic medical security for urban workers; Basic medical security for urban residents; New rural cooperative medical system

Problems and the Potential Direction of Reforms for the Current Individual Medical Savings Accounts in the Chinese Health Care System

Individual health savings accounts are an important part of the current basic medical insurance system for urban workers in China. Since 1998 when the system of personal medical insurance accounts was first implemented, there has been considerable controversy over its function and significance within different social communities. This paper analyzes the main problems in the practical implementation of individual medical insurance accounts and discusses the social and cultural foundations for the establishment of family health savings accounts from the perspective of Chinese Confucian familism. Accordingly, it addresses the direction of the reform and the development of the current system of individual health insurance accounts in China.

Moving towards universal health insurance in China: Performance, issues and lessons from Thailand

China is now in the course of implementing a new round of health system reforms. Universal health insurance coverage through the basic social medical insurance system is high on the reform agenda. This paper examines the performance of China’s current social medical insurance system in terms of revenue collection, risk pooling, the benefit package, and provider payment mechanisms based on a literature review and publicly available data. On the basis of critical assessment, the paper attempts to address the issues challenging China as it moves towards universal coverage. Focusing in particular on the reform experience in Thailand as it implemented universal coverage, the following policy implications for further reform in China are articulated, taking into account China’s particular circumstances: firstly, the gaps in the benefit package across different schemes should be further reduced; secondly, the prevailing fee-for-service payment system needs to be transformed; thirdly, the primary health care delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and fourthly, raising the risk pooling level and integrating fragmented insurance schemes should be long-run objectives of reform.

Medical insurance system evolution in China

Healthcare financing and payment in China are mainly based on medical insurance. This paper examines the key issues of the Chinese medical insurance system, with a particular emphasis on basic social medical insurance, which has the broadest coverage in China. It reviews the evolution of the basic social medical insurance system, describes how the system functions, and analyzes the existing and emerging problems with the system. The paper concludes with a discussion of some suggestions for the future development of the system.

A Study of Healthcare Reform in China in Light of the USA and Canadian Systems

This article describes and examines the newly implemented basic medical insurance system for urban employees in China. The insurance system was built on two distinct concepts, individual providence and social insurance, and was characterized by national government mandates, local government administration, and employer/employee contributions. The study found that the Chinese basic medical insurance program for urban employees was implemented in all major urban areas. About 130 million people were covered under the scheme as of May 2005. The program benefits are limited with relatively low ceilings on reimbursable expenses and high cost sharing from the insured. The procedure for reimbursement is complicated and time consuming. China can learn from the U.S. and Canadian systems in both financing and providing healthcare. The U.S. system arguably supplies the best medical services in terms of quality and accessibility for those who are insured and those who can pay out of pocket. But the huge costs may not work well with China at present. The Canadian system, which is relatively effective, efficient, and equitable, although not as accessible, may fit China better. The study also suggests that the U.S. employer-based healthcare insurance system requires a major overhaul. It puts U.S. companies at a disadvantaged position in the increasingly competitive global marketplace.