Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China

Zhao, Miaomiao and Liu, Baohua and Shan, Linghan and Li, Cui and Wu, Qunhong and Hao, Yanhua and Chen, Zhuo and Lan, Lan and Kang, Zheng and Liang, Libo and Ning, Ning and Jiao, Mingli (2019) Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China. BMC Health Services Research, 19 . 654/1-654/11. ISSN 1472-6963

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Abstract

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 ieffectiveness.



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.

Item Type: Article
Additional Information: The work is licenced to the University of Nottingham Ningbo China under the Global University Publication Licence.
Keywords: medical insurance integration; inequity; inequality; inpatient service utilization
Schools/Departments: University of Nottingham Ningbo China > Faculty of Humanities and Social Sciences > School of Economics
Identification Number: https://doi.org/10.1186/s12913-019-4480-8
Depositing User: Yu, Tiffany
Date Deposited: 19 Sep 2019 13:46
Last Modified: 19 Sep 2019 13:46
URI: http://eprints.nottingham.ac.uk/id/eprint/59099

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