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Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China

BACKGROUND: China’s fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates...

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Autores principales: Wang, Jiahui, Zhu, Hong, Liu, Huan, Wu, Ke, Zhang, Xin, Zhao, Miaomiao, Yin, Hang, Qi, Xinye, Hao, Yanhua, Li, Ye, Liang, Libo, Jiao, Mingli, Xu, Jiao, Liu, Baohua, Wu, Qunhong, Shan, Linghan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7126184/
https://www.ncbi.nlm.nih.gov/pubmed/32245473
http://dx.doi.org/10.1186/s12939-020-1145-5
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author Wang, Jiahui
Zhu, Hong
Liu, Huan
Wu, Ke
Zhang, Xin
Zhao, Miaomiao
Yin, Hang
Qi, Xinye
Hao, Yanhua
Li, Ye
Liang, Libo
Jiao, Mingli
Xu, Jiao
Liu, Baohua
Wu, Qunhong
Shan, Linghan
author_facet Wang, Jiahui
Zhu, Hong
Liu, Huan
Wu, Ke
Zhang, Xin
Zhao, Miaomiao
Yin, Hang
Qi, Xinye
Hao, Yanhua
Li, Ye
Liang, Libo
Jiao, Mingli
Xu, Jiao
Liu, Baohua
Wu, Qunhong
Shan, Linghan
author_sort Wang, Jiahui
collection PubMed
description BACKGROUND: China’s fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS), can curb the persistent inequity of catastrophic health expenditure (CHE) and further analyses the determinants causing inequity. METHODS: Data were derived from the Fifth National Health Service Survey (NHSS). A total of 11,104 households covered by URRBMI and 20,590 households covered by URBMI or NCMS were selected to analyze CHE and the impoverishment rate from medical expenses. Moreover, the decomposition method based on a probit model was employed to analyse factors contributing CHE inequity. RESULTS: The overall incidence of CHE under integrated insurance scheme was 15.53%, about 1.10% higher than the non-integrated scheme; however, the intensity of CHE and impoverishment among the poorest was improved. Although CHE was still concentrated among the poor under URRBMI (CI = -0.53), it showed 28.38% lower in the degree of inequity. For URRBMI households, due to the promotion of integration reform to the utilization of rural residents’ better health services, the factor of residence (24.41%) turns out to be a major factor in increasing inequity, the factor of households with hospitalized members (− 84.53%) played a positive role in reducing inequity and factors related to social economic status also contributed significantly in increasing inequity. CONCLUSION: The progress made in the integrated URRBMI on CHE equity deserves recognition, even though it did not reduce the overall CHE or the impoverishment rate effectively. Therefore, for enhanced equity, more targeted solutions should be considered, such as promoting more precise insurance intervention for the most vulnerable population and including costly diseases suitable for outpatient treatment into benefit packages. Additionally, comprehensive strategies such as favourable targeted benefit packages or job creation are required for the disadvantaged.
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spelling pubmed-71261842020-04-10 Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China Wang, Jiahui Zhu, Hong Liu, Huan Wu, Ke Zhang, Xin Zhao, Miaomiao Yin, Hang Qi, Xinye Hao, Yanhua Li, Ye Liang, Libo Jiao, Mingli Xu, Jiao Liu, Baohua Wu, Qunhong Shan, Linghan Int J Equity Health Research BACKGROUND: China’s fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS), can curb the persistent inequity of catastrophic health expenditure (CHE) and further analyses the determinants causing inequity. METHODS: Data were derived from the Fifth National Health Service Survey (NHSS). A total of 11,104 households covered by URRBMI and 20,590 households covered by URBMI or NCMS were selected to analyze CHE and the impoverishment rate from medical expenses. Moreover, the decomposition method based on a probit model was employed to analyse factors contributing CHE inequity. RESULTS: The overall incidence of CHE under integrated insurance scheme was 15.53%, about 1.10% higher than the non-integrated scheme; however, the intensity of CHE and impoverishment among the poorest was improved. Although CHE was still concentrated among the poor under URRBMI (CI = -0.53), it showed 28.38% lower in the degree of inequity. For URRBMI households, due to the promotion of integration reform to the utilization of rural residents’ better health services, the factor of residence (24.41%) turns out to be a major factor in increasing inequity, the factor of households with hospitalized members (− 84.53%) played a positive role in reducing inequity and factors related to social economic status also contributed significantly in increasing inequity. CONCLUSION: The progress made in the integrated URRBMI on CHE equity deserves recognition, even though it did not reduce the overall CHE or the impoverishment rate effectively. Therefore, for enhanced equity, more targeted solutions should be considered, such as promoting more precise insurance intervention for the most vulnerable population and including costly diseases suitable for outpatient treatment into benefit packages. Additionally, comprehensive strategies such as favourable targeted benefit packages or job creation are required for the disadvantaged. BioMed Central 2020-04-03 /pmc/articles/PMC7126184/ /pubmed/32245473 http://dx.doi.org/10.1186/s12939-020-1145-5 Text en © The Author(s). 2020 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
Wang, Jiahui
Zhu, Hong
Liu, Huan
Wu, Ke
Zhang, Xin
Zhao, Miaomiao
Yin, Hang
Qi, Xinye
Hao, Yanhua
Li, Ye
Liang, Libo
Jiao, Mingli
Xu, Jiao
Liu, Baohua
Wu, Qunhong
Shan, Linghan
Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China
title Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China
title_full Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China
title_fullStr Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China
title_full_unstemmed Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China
title_short Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China
title_sort can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? evidence from china
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7126184/
https://www.ncbi.nlm.nih.gov/pubmed/32245473
http://dx.doi.org/10.1186/s12939-020-1145-5
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