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Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China

BACKGROUND: Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China’s health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpati...

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Autores principales: Zhao, Miaomiao, Liu, Baohua, Shan, Linghan, Li, Cui, Wu, Qunhong, Hao, Yanhua, Chen, Zhuo, Lan, Lan, Kang, Zheng, Liang, Libo, Ning, Ning, Jiao, Mingli
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734466/
https://www.ncbi.nlm.nih.gov/pubmed/31500617
http://dx.doi.org/10.1186/s12913-019-4480-8
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author Zhao, Miaomiao
Liu, Baohua
Shan, Linghan
Li, Cui
Wu, Qunhong
Hao, Yanhua
Chen, Zhuo
Lan, Lan
Kang, Zheng
Liang, Libo
Ning, Ning
Jiao, Mingli
author_facet Zhao, Miaomiao
Liu, Baohua
Shan, Linghan
Li, Cui
Wu, Qunhong
Hao, Yanhua
Chen, Zhuo
Lan, Lan
Kang, Zheng
Liang, Libo
Ning, Ning
Jiao, Mingli
author_sort Zhao, Miaomiao
collection PubMed
description BACKGROUND: Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China’s health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness. METHODS: A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. RESULTS: Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. CONCLUSIONS: The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4480-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-67344662019-09-12 Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China Zhao, Miaomiao Liu, Baohua Shan, Linghan Li, Cui Wu, Qunhong Hao, Yanhua Chen, Zhuo Lan, Lan Kang, Zheng Liang, Libo Ning, Ning Jiao, Mingli BMC Health Serv Res Research Article BACKGROUND: Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China’s health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness. METHODS: A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. RESULTS: Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. CONCLUSIONS: The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4480-8) contains supplementary material, which is available to authorized users. BioMed Central 2019-09-10 /pmc/articles/PMC6734466/ /pubmed/31500617 http://dx.doi.org/10.1186/s12913-019-4480-8 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zhao, Miaomiao
Liu, Baohua
Shan, Linghan
Li, Cui
Wu, Qunhong
Hao, Yanhua
Chen, Zhuo
Lan, Lan
Kang, Zheng
Liang, Libo
Ning, Ning
Jiao, Mingli
Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China
title Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China
title_full Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China
title_fullStr Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China
title_full_unstemmed Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China
title_short Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China
title_sort can integration reduce inequity in healthcare utilization? evidence and hurdles in china
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734466/
https://www.ncbi.nlm.nih.gov/pubmed/31500617
http://dx.doi.org/10.1186/s12913-019-4480-8
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