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Zhou Q, Eggleston K, Liu GG. Health insurance and subjective well-being: evidence from integrating medical insurance across urban and rural areas in China. Health Policy Plan 2024; 39:564-582. [PMID: 38648378 PMCID: PMC11145920 DOI: 10.1093/heapol/czae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 03/05/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.
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Affiliation(s)
- Qin Zhou
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Street, 323# Qiushi Building, Haidian, Beijing 100872, China
| | - Karen Eggleston
- Walter H. Shorenstein Asia-Pacific Research Center, Stanford University and NBER, Encina Hall E311, Stanford, CA 94305-6055, United States
| | - Gordon G Liu
- Institute for Global Health and Development; National School of Development, Peking University, Langrun Garden, Beijing 100871, China
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Qin Z, Liu S, Zhou M, Chen L, Huang W, Shen L. Impacts of unifying urban and rural residents' medical insurance on the hospitalisation expenses of rural patients in eastern China: an interrupted time series analysis. BMJ Open 2023; 13:e067198. [PMID: 37230522 DOI: 10.1136/bmjopen-2022-067198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES This study evaluated the impact of the Urban and Rural Residents' Basic Medical Insurance scheme on hospitalisation expenses of rural patients in eastern China, which unified separate healthcare systems for urban and rural residents. DESIGN Monthly hospitalisation data from municipal and county hospitals were collected from the local Medicare Fund Database, covering the period from January 2018 to December 2021. The unification of insurance between urban and rural patients was implemented at different times for county and municipal hospitals. An interrupted time series analysis was used to assess the immediate and gradual effects of the integrated policy on the total medical expenses, out-of-pocket (OOP) expenses and effective reimbursement rate (ERR) among rural patients. SETTING AND PARTICIPANTS This study included 636 155 rural inpatients over 4 years in Xuzhou City, Jiangsu Province, China. RESULTS In January 2020, the policy of urban and rural medical insurance was initially integrated in county hospitals, after which the ERR decreased at a monthly rate of 0.23% (p=0.002, 95% CI -0.37% to -0.09%) compared with the preintervention period. After the insurance systems were unified in municipal hospitals in January 2021, OOP expenses decreased by ¥63.54 (p=0.002, 95% CI -102.48 to -24.61) and the ERR increased at a monthly rate of 0.24% (p=0.029, 95% CI 0.03% to 0.045%). CONCLUSIONS Our results suggest that the unification of urban and rural medical insurance systems was an effective intervention to reduce the financial burden of illness for rural inpatients, especially OOP expenses for hospitalisation in municipal hospitals.
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Affiliation(s)
- Zhaohui Qin
- School of Economics and Management, China University of Mining and Technology, Xuzhou, China
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Min Zhou
- School of Economics and Management, China University of Mining and Technology, Xuzhou, China
| | - Lijiang Chen
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Wenhao Huang
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Liang Shen
- School of Management, Xuzhou Medical University, Xuzhou, China
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Xu J, Tian G, Sun J, Liu J, Chen F, Shi Q, Zhang T, Zhang H, He J, Deng F, Zhang B, Wang H, Wu Q, Kang Z. Horizontal inequity trends of health care utilization in rural China after the medicine and healthcare system reform: based on longitudinal data from 2010 to 2018. Int J Equity Health 2023; 22:90. [PMID: 37194035 DOI: 10.1186/s12939-023-01908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND To assess the effectiveness of China's medicine and health care reform in promoting equity in health care utilization among rural residents, it is necessary to analyze temporal trends in equity in health care utilization among rural residents in China. This study is the first to assess horizontal inequity trends in health care utilization among rural Chinese residents from 2010 to 2018 and provides evidence for improving government health policies. METHODS Longitudinal data obtained from China Family Panel Studies from 2010 to 2018 were used to determine trends in outpatient and inpatient utilization. Concentration index, concentration curve, and horizontal inequity index were calculated to measure inequalities. Decomposition analysis was applied to measure the contribution of need and non-need factors to the unfairness. RESULTS From 2010 to 2018, outpatient utilization among rural residents increased by 35.10%, while inpatient utilization increased by 80.68%. Concentration indices for health care utilization were negative in all years. In 2012, there was an increase in the concentration index for outpatient utilization (CI = -0.0219). The concentration index for inpatient utilization decreased from -0.0478 in 2010 to -0.0888 in 2018. Except for outpatient utilization in 2012 (HI = 0.0214), horizontal inequity indices for outpatient utilization were negative in all years. The horizontal inequity index for inpatient utilization was highest in 2010 (HI = -0.0068) and lowest in 2018 (HI = -0.0303). The contribution of need factors to the inequity exceeded 50% in all years. CONCLUSIONS Between 2010 and 2018, low-income groups in rural China used more health services. This seemingly pro-poor income-related inequality was due in large part to the greater health care need among low-income groups. Government policies aimed at increasing access to health services, particularly primary health care had helped to make health care utilization in rural China more equitable. It is necessary to design better health policies for disadvantaged groups to reduce future inequities in the use of health services by rural populations.
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Affiliation(s)
- Jinpeng Xu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Guomei Tian
- Department of Nuclear Medicine, The Fourth Hospital of Harbin Medical University, Harbin, China
| | - Jiale Sun
- Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Jian Liu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Fangting Chen
- School of Health Management, Harbin Medical University, Harbin, China
| | - Qi Shi
- School of Health Management, Harbin Medical University, Harbin, China
| | - Ting Zhang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Hongyu Zhang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Jingran He
- School of Health Management, Harbin Medical University, Harbin, China
| | - Fangmin Deng
- School of Health Management, Harbin Medical University, Harbin, China
| | - Bokai Zhang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Haixin Wang
- School of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Harbin, China
| | - Zheng Kang
- School of Health Management, Harbin Medical University, Harbin, China.
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Teng L, Dai Y, Peng T, Su Y, Pan L, Li Y. Explaining the intention and behaviours of interinstitutional collaboration in chronic disease management among health care personnel: a cross-sectional study from Fujian Province, China. BMC Health Serv Res 2023; 23:477. [PMID: 37170223 PMCID: PMC10174609 DOI: 10.1186/s12913-023-09453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The increasing number of chronic diseases consumes a large amount of health resources and puts a huge burden on health service system. The integrated management of chronic diseases in Sanming City aims to improve the efficiency and quality of chronic disease management through the collaboration between different levels of medical institutions. AIM The aim of the present study was to use the theory of planned behaviour (TPB) to examine the intention and behaviours of interinstitutional collaboration in chronic disease management (ICCDM) among healthcare personnel. METHODS A cross-sectional study of 274 health care personnel was conducted in medical institutions in Fujian Province, China, from March 2022 to April 2022. A self-administered questionnaire based on TPB theory was applied to measure the participants' ICCDM behaviours. RESULTS The proposed TPB model revealed that attitude was significantly and positively associated with behaviour intention, and behaviour intention and perceived behavioural control were significant predictors of ICCDM behaviour. CONCLUSION TPB provides insights into ICCDM behaviour. Due to the fact that attitude, perceived behavioural control, and behavioural intention towards ICCDM behaviour were demonstrated to be significant predictors of ICCDM behaviour, these factors may be a promising focus of ICCDM interventions in the integrated management of chronic diseases in China.
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Affiliation(s)
- Li Teng
- The School of Public Health, Fujian Medical University, Fuzhou, China
- The School of Management, North Sichuan Medical College, Nanchong, China
| | - Yue Dai
- The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Tao Peng
- The School of Basic Medicine, North Sichuan Medical College, Nanchong, China
| | - Yuan Su
- The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Lingyi Pan
- The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yueping Li
- The School of Arts and Sciences, Fujian Medical University, No. 1, Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, China.
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Li Q, Zhang L, Jian W. The impact of integrated urban and rural resident basic medical insurance on health service equity: Evidence from China. Front Public Health 2023; 11:1106166. [PMID: 36992886 PMCID: PMC10040545 DOI: 10.3389/fpubh.2023.1106166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundMany countries and regions worldwide are improving their healthcare systems through the integration and unification of health insurance programs covering different groups of people. In China, the past 10 years has been the time when Chinese government promote the Urban and Rural Residents Basic Medical Insurance (URRBMI) by integrating the Urban Residents' Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS).ObjectivesTo evaluate the impact of the URRBMI on equity in relation to health services.MethodsThe quantitative data used in this study were obtained from the CFPS 2014–2020 database, and all respondents with health insurance type UEBMI, URBMI, and NRCMS were included. UEBMI respondents were set as the control group and URBMI or NRCMS as the intervention group, and a DID method model was used to analyze the impact of integrating health insurance on health service utilization, costs and health status. Heterogeneity analysis was also conducted after stratifying the sample according to income level and chronic disease status. This was done to investigate whether there were differences in the effects of the integrated health insurance program across different social groups.ResultsThe implementation of URRBMI is found to be associated with a significant increase in inpatient service utilization (OR = 1.51, P < 0.01) among rural Chinese residents. Regression results by income stratum show that the utilization of inpatient services increased in rural areas for high-, middle- and low-income groups, with the fastest increase (OR = 1.78, P < 0.05) emerging for low-income groups. Analysis by chronic disease status shows that rural residents with chronic disease are associated with a higher increase in hospitalization rates (OR = 1.64, P < 0.01).ConclusionThe implementation of URRBMI is found to have improved health insurance's ability to withstand risks and effectively improve access to health services for rural residents. In this regard, it can be considered as playing a positive role in bridging the gap in health service utilization between rural and urban areas and in improving regional equity.
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Li Y, Yang Y, Yuan J, Huang L, Ma Y, Shi X. Differences in medical costs among urban lung cancer patients with different health insurance schemes: a retrospective study. BMC Health Serv Res 2022; 22:612. [PMID: 35524258 PMCID: PMC9077891 DOI: 10.1186/s12913-022-07957-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 04/15/2022] [Indexed: 02/05/2023] Open
Abstract
Background Health insurance plays a significant role in reducing the financial burden for lung cancer patients. However, limited research exists regarding the differences in medical costs for lung cancer patients with different insurance schemes across different cities. We aimed to assess disparities in lung cancer patients’ costs by insurance type and city–specific insurance type. Methods Claim data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) between 2010 and 2016 were employed to investigate differences in medical costs. This study primarily applied descriptive analysis and a generalized linear model with a gamma distribution and a log link. Results In total, 92,856 lung cancer patients with inpatient records were identified, with Renminbi (RMB) 11,276 [6322–20,850] (median [interquartile range]) medical costs for the UEBMI group and RMB 8303 [4492–14,823] for the URBMI group. Out–of–pocket (OOP) expenses for the UEBMI group was RMB 2143 [1108–4506] and RMB 2975 [1367–6275] for the URBMI group. The UEBMI group also had significantly higher drug costs, medical service costs, and medical consumable costs, compared to the URBMI group. Regarding city-specific insurances, medical costs for the UEBMI and the URBMI lung cancer patients in Shanghai were RMB 9771 [5183–16,623] and RMB 9741 [5924–16,067], respectively. In Xianyang, the medical costs for UEBMI and URBMI patients were RMB 11,398 [6880–20,648] and RMB 9853 [5370–24,674], respectively. The regression results showed that the UEBMI group had 27.31% fewer OOP expenses than the URBMI group did, while patients in Xiangyang and Xianyang had 39.53 and 35.53% fewer OOP expenses, respectively, compared to patients in Shanghai. Conclusions Compared with the URBMI patients, the UEBMI lung cancer patients obtained more or even better health services and had reduced financial burden. The differences in insurances among cities were greater, compared to those among insurances within cities, and the differences in OOP expenses between cities were greater compared to those between UEBMI and URBMI. Our results called for further reform of China’s fragmented insurance schemes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07957-9.
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Affiliation(s)
- Yichen Li
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yong Yang
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.,School of Management, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Jia Yuan
- West China Hospital, Sichuan University, Chengdu, China
| | - Lieyu Huang
- Office of Policy and Planning Research, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yong Ma
- China Health Insurance Research Association, Beijing, China. .,National Institute of Healthcare Security, Capital Medical University, Beijing, 100037, China.
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, People's Republic of China. .,National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China.
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Zhang X, Ning N, Zhou H, Shan L, Hao Y, Jiao M, Liang L, Kang Z, Li Y, Liu H, Liu B, Wang K, Ruzieva A, Gao L, Wu Q. Inequity in Health Services Utilization in Economically Underdeveloped Regions of Northeast China. Front Public Health 2022; 10:850157. [PMID: 35493377 PMCID: PMC9051237 DOI: 10.3389/fpubh.2022.850157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Chinese health system has long been committed to eliminating inequalities in health services utilization. However, few studies have analyzed or measured these inequalities in economically underdeveloped regions in China.MethodsA total of 6,627 respondents from 3,000 households in Heilongjiang Province were extracted from the Sixth National Health Services Survey. We measured horizontal inequity in both 2-week outpatient rate and annual inpatient rate, and then identified the factors contributing to inequality.ResultsThe horizontal inequity indices of the 2-week outpatient and annual impatient rates in Heilongjiang Province were 0.0586 and 0.1276, respectively. Household income, health status, place of residence, basic medical insurance, and commercial health insurance were found to be the main factors affecting inequality in health services utilization. The contributions of household income to these two indices were 184.03 and 253.47%, respectively. Health status factors, including suffering from chronic disease, limitations in daily activities, and poor self-rated health, played positive roles in reducing inequality in these two indices. The contributions of place of residence to these two indices were 27.21 and −28.45%, respectively. Urban Employee Basic Medical Insurance made a pro-rich contribution to these two indices: 56.25 and 81.48%, respectively. Urban and Rural Resident Basic Medical Insurance, Urban Resident Basic Medical Insurance, New Rural Cooperative Medical Scheme, and other basic medical insurance made a pro-poor contribution to these two indices: −73.51 and −54.87%, respectively. Commercial health insurance made a pro-rich contribution to these two indices: 20.79 and 7.40%, respectively. Meanwhile, critical illness insurance made a slightly pro-poor contribution to these two indices: −4.60 and −0.90%, respectively.ConclusionsThe findings showed that the “equal treatment in equal need” principle was not met in the health services utilization context in Heilongjiang Province. To address this issue, the government could make policy changes to protect low-income populations from underused health services, and work to improve basic medical insurance, critical illness insurance, and social security systems.
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Affiliation(s)
- Xin Zhang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Ning Ning
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Hongguo Zhou
- Office of Educational Administration, Ningbo College of Health Sciences, Ningbo, China
| | - Linghan Shan
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Libo Liang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Ye Li
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Huan Liu
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Baohua Liu
- School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, China
| | - Kexin Wang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Adelina Ruzieva
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Lijun Gao
| | - Qunhong Wu
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- Qunhong Wu
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Geng J, Chen X, Shi J, Bao H, Chen Q, Yu H. Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach. BMC Public Health 2021; 21:1886. [PMID: 34663271 PMCID: PMC8524814 DOI: 10.1186/s12889-021-11947-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China's public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap. METHODS We established a hypothetical model that comprised patients' awareness of insurance policies, the fulfillment of patients' expectations of insurance benefits, patients' perceived value of health insurance coverage, patients' satisfaction with health insurance programs, patients' complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases. RESULTS The SEM model, with good fit indices, showed that patients' awareness of health insurance policies, insurance program's fulfillment of expectations, and patients' perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients' expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients' perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis. CONCLUSIONS Our findings highlight the importance of incorporating patients' perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients' expectations.
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Affiliation(s)
- Jinsong Geng
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.
| | - Xiaowei Chen
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.,Library and Reference Department, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Haini Bao
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Qian Chen
- Department of Ophthalmology, The Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
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Wang J, Tan X, Qi X, Zhang X, Liu H, Wang K, Jiang S, Xu Q, Meng N, Chen P, Li Y, Kang Z, Wu Q, Shan L, Amporfro DA, Ilia B. Minimizing the Risk of Catastrophic Health Expenditure in China: A Multi-Dimensional Analysis of Vulnerable Groups. Front Public Health 2021; 9:689809. [PMID: 34422747 PMCID: PMC8377675 DOI: 10.3389/fpubh.2021.689809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background: In moving toward universal health coverage in China, it is crucial to identify which populations should be prioritized for which interventions rather than blindly increasing welfare packages or capital investments. We identify the characteristics of vulnerable groups from multiple perspectives through estimating catastrophic health expenditure (CHE) and recommend intervention priorities. Methods: Data were from National Health Service Survey conducted in 2003, 2008, and 2013. According to the recommendation of WHO, this study adopted 40% as the CHE threshold. A binary regression was used to identify the determinants of CHE occurrence; a probit model was used to obtain CHE standardized incidence under the characteristics of single and two dimensions in 2013. Results: The total incidence of CHE in 2013 was 13.9%, which shows a general trend of growth from 2003 to 2013. Families in western and central regions and rural areas were more at risk. Factors related to social demography show that households with a female or an unmarried head of household or with a low socioeconomic status were more likely to experience CHE. Households with older adults aged 60 and above had 1,524 times higher likelihood of experiencing CHE. Among the health insurance schemes, the participants covered by the New Rural Cooperative Medical Scheme had the highest risk compared with the participants of all basic health insurance schemes. Households with several members seeking outpatient, inpatient care or with non-communicable diseases were more likely to experience CHE. Households with members not seeing a doctor or hospitalized despite the need for it were more likely to experience CHE. Characteristics such as a household head with characteristics related to low socioeconomic status, having more than two hospitalized family members, ranked high. Meanwhile, the combination of having illiterate household heads and with being covered by other health insurance plans or by none ranked the first place. Cancer notably caused a relatively high medical expenditure among households with CHE. Conclusion: In China, considering the vulnerability of the population across different dimensions is conducive to the alleviation of high CHE. Furthermore, people with multiple vulnerabilities should be prioritized for intervention. Identifying and targeting them to offer help and support will be an effective approach.
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Affiliation(s)
- Jiahui Wang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Xiao Tan
- Shenzhen Hospital of Guangzhou University of Traditional Chinese Medicine (Futian), Shenzhen, China
| | - Xinye Qi
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Xin Zhang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Huan Liu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Kexin Wang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Shengchao Jiang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Qiao Xu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Nan Meng
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Peiwen Chen
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Ye Li
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Linghan Shan
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Daniel Adjei Amporfro
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Bykov Ilia
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
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10
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Dong W, Zwi AB, Bai R, Shen C, Gao J. Benefit of China's Social Health Insurance Schemes: Trend Analysis and Associated Factors Since Health Reform. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5672. [PMID: 34070687 PMCID: PMC8199469 DOI: 10.3390/ijerph18115672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022]
Abstract
With the deepening of health insurance reform in China, the integration of social health insurance schemes was put on the agenda. This paper aims to illustrate the achievements and the gaps in integration by demonstrating the trends in benefits available from the three social health insurance schemes, as well as the influencing factors. Data were drawn from the three waves of the China Health and Nutrition Survey (2009, 2011, 2015) undertaken since health reforms commenced. χ2, Kruskal-Wallis test, and the Two-Part model were employed in the analysis. The overall reimbursement rate of the Urban Employee Basic Medical Insurance (UEBMI) is higher than that of Urban Resident Basic Medical Insurance (URBMI) or the New Rural Cooperative Medical Scheme (NRCMS) (p < 0.001), but the gap has narrowed since health reform began in 2009. Both the outpatient and inpatient reimbursement amounts have increased through the URBMI and NRCMS. Illness severity, higher institutional level, and inpatient service were associated with significant increases in the amount of reimbursement received across the three survey waves. The health reform improved benefits covered by the URBMI and NRCMS, but gaps with the UEBMI still exist. The government should consider more the release of health benefits and how to lead toward healthcare equity.
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Affiliation(s)
- Wanyue Dong
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 210023, China;
| | - Anthony B. Zwi
- School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales, Kensington 2052, Australia
| | - Ruhai Bai
- School of Public Affairs, Nanjing University of Science and Technology, Nanjing 210094, China;
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an 710049, China;
| | - Jianmin Gao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an 710049, China;
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11
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Qu X, Qi X, Wu B. Disparities in Dental Service Utilization among Adults in Chinese Megacities: Do Health Insurance and City of Residence Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186851. [PMID: 32961720 PMCID: PMC7559892 DOI: 10.3390/ijerph17186851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/22/2022]
Abstract
The aims of the study were to present the prevalence of dental service utilization among adults (age between 18 and 65) in Chinese megacities and to examine the associations of health insurance and city of residence with dental visits. This study was a cross-sectional analysis of the 2019 New Era and Living Conditions in Megacities Survey data with a sample of 4835 participants aged 18–65 from 10 different megacities in China. The data including gross domestic product (GDP) per capita of each megacity obtained from the National Bureau of Statistics of China as a city-level characteristic. After adjusting sampling weights, approximately 24.28% of the participants had at least one dental visit per year. Findings from multilevel mixed-effects linear models showed that participants residing in megacities with higher GDP per capita (β = 0.07, p < 0.001) who had Urban Employee Basic Medical Insurance (β = 0.25, p < 0.001) or Urban Resident Basic Medical Insurance (β = 0.19, p < 0.01) had more frequent dental visits after adjusting demographic characteristics, socioeconomic status, health status, health behavior and attitude, and oral health indicators. Margins post-estimation model results demonstrated disparities in the predicted probability of having never visited a dentist by types of health insurance and city of residence. In conclusion, the prevalence of dental visits in China was found to be low. This study highlights socioeconomic inequalities in dental service utilization. There is a great need to develop more dental care programs and services and expand health insurance to cover dental care in China.
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Affiliation(s)
- Xiaomin Qu
- School of Social Development, East China University of Political Science and Law, 555 Longyuan Road Songjiang District, Shanghai 201620, China;
| | - Xiang Qi
- Rory Meyer College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA;
| | - Bei Wu
- Rory Meyer College of Nursing, NYU Aging Incubator, New York University, 433 First Avenue, New York, NY 10010, USA
- Correspondence: ; Tel.: +1-212-992-5951
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12
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Wang J, Pei Y, Zhong R, Wu B. Outpatient Visits among Older Adults Living Alone in China: Does Health Insurance and City of Residence Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124256. [PMID: 32549227 PMCID: PMC7344973 DOI: 10.3390/ijerph17124256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 11/16/2022]
Abstract
This study aimed to examine the association between health insurance, city of residence, and outpatient visits among older adults living alone in China. A sample of 3173 individuals was derived from “Survey on Older Adults Aged 70 and Above Living Alone in Urban China” in five different cities. Logistic regression models indicated that older adults living alone who had urban employee basic medical insurance, urban resident basic medical insurance, and public medical insurance were more likely to have outpatient visits than those without any health insurance. After controlling the number of chronic diseases, only those with public medical insurance were more likely to have outpatient visits than uninsured older adults. Additionally, older adults who resided in Shanghai and Guangzhou were more likely to have outpatient visits than those in Chengdu, whereas older adults who were in Dalian and Hohhot were less likely to have outpatient visits. To improve the equity of outpatient visits among older adults living alone in China, policy efforts should be made to reduce fragmentation of different health insurance plans, expand the health insurance coverage for older adults, provide programs that consider the needs of this special group of older adults, and reduce the inequality in health resources and health insurance policies across cities.
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Affiliation(s)
- Jianyun Wang
- School of Public Administration, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China;
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA;
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA;
| | - Renyao Zhong
- School of Public Administration, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China;
- Correspondence: (R.Z.); (B.W.); Tel.: +86-021-6223-8720 (R.Z.); +1-212-992-5951 (B.W.)
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA;
- NYU Aging Incubator, New York University, 433 First Avenue, New York, NY 10010, USA
- Correspondence: (R.Z.); (B.W.); Tel.: +86-021-6223-8720 (R.Z.); +1-212-992-5951 (B.W.)
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13
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Wang J, Zhu H, Liu H, Wu K, Zhang X, Zhao M, Yin H, Qi X, Hao Y, Li Y, Liang L, Jiao M, Xu J, Liu B, Wu Q, Shan L. Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China. Int J Equity Health 2020; 19:49. [PMID: 32245473 PMCID: PMC7126184 DOI: 10.1186/s12939-020-1145-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Jiahui Wang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Hong Zhu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Huan Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Ke Wu
- Tong Zhou District's Volunteer Services Guidance Center of Beijing Municipality, Beijing, China
| | - Xin Zhang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Miaomiao Zhao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, China
| | - Hang Yin
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Xinye Qi
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Yanhua Hao
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Ye Li
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Libo Liang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Mingli Jiao
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Jiao Xu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Baohua Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Qunhong Wu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China.
| | - Linghan Shan
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China.
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14
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Liu H, Zhu H, Wang J, Qi X, Zhao M, Shan L, Gao L, Kang Z, Jiao M, Pan L, Chen R, Liu B, Wu Q, Ning N. Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system. BMC Public Health 2019; 19:1761. [PMID: 31888591 PMCID: PMC6937839 DOI: 10.1186/s12889-019-8121-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. METHODS The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. RESULTS The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is - 0.071 and - 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders' educational attainment both in integrated areas and non-integrated areas. CONCLUSIONS The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.
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Affiliation(s)
- Huan Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Hong Zhu
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Jiahui Wang
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Xinye Qi
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Miaomiao Zhao
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Linghan Shan
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Lin Pan
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Ruohui Chen
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Baohua Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China.
| | - Ning Ning
- Department of Social Medicine, Health Management College, Harbin Medical University, Harbin, China.
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