Chinese residents’ educational disparity and social insurance coverage

2018 ◽  
Vol 31 (7) ◽  
pp. 746-756 ◽  
Author(s):  
Yen-Han Lee ◽  
Timothy Chiang ◽  
Mack Shelley ◽  
Ching-Ti Liu
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Central Government ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Medical Insurance ◽  
Social Health ◽  
Content Type ◽  
Basic Medical Insurance ◽  
Basic Medical

Purpose The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China’s social health insurance scheme following the reform. Design/methodology/approach Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design (n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported. Findings The authors found that education is associated with all social health insurance schemes in China after the reform (p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44–8.13) or university and above (OR: 9.86, 95% CI: 8.14–11.96), are associated with UEBMI, compared with lower-educated individuals. Practical implications The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China’s universal health coverage and social disparity. Originality/value This study is the first to investigate the association between residents’ educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.

scholarly journals Benefit of China’s Social Health Insurance Schemes: Trend Analysis and Associated Factors Since Health Reform

2021 ◽  
Vol 18 (11) ◽  
pp. 5672
Author(s):  
Wanyue Dong ◽  
Anthony B. Zwi ◽  
Ruhai Bai ◽  
Chi Shen ◽  
Jianmin Gao
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Social Health Insurance ◽  
Medical Insurance ◽  
Social Health ◽  
Inpatient Service ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
Basic Medical Insurance ◽  
Basic Medical

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.

scholarly journals Patients’ preferences for health insurance coverage of new technologies for treating chronic diseases in China: a discrete choice experiment

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038051
Author(s):  
Jinsong Geng ◽  
Xiaowei Chen ◽  
Haini Bao ◽  
Danmin Qian ◽  
Yuting Shao ◽  
...  
Keyword(s):  
Health Insurance ◽  
Chronic Diseases ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
New Technologies ◽  
Insurance Coverage ◽  
Medical Insurance ◽  
Basic Medical Insurance ◽  
Basic Medical

ObjectivesOur study aimed to inform insurance decision-making in China by investigating patients’ preferences for insurance coverage of new technologies for treating chronic diseases.DesignWe identified six attributes of new medical technologies for treating chronic diseases and used Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). After conducting the DCE, we analysed the data by mixed logit regression to examine patient-reported preferences for each attribute.SettingThe DCE was conducted with patients in six tertiary hospitals from four cities in Jiangsu province.ParticipantsPatients aged 18 years or older with a history of diabetes or hypertension and taking medications regularly for more than 1 year were recruited (n=408).ResultsThe technology attributes regarding expected gains in health outcomes from the treatment, high likelihood of effective treatment and low incidence of serious adverse events were significant, positive predictors of choice by the study patients (p<0.01). The out-of-pocket cost was a significant, negative attribute for the entire study sample (β = −0.258, p<0.01) and for the patients with Urban-Rural Residents Basic Medical Insurance (URRBMI) (β = −0.511, p<0.01), but not for all the patients with Urban Employees Basic Medical Insurance (UEBMI) (β = −0.071, p>0.05). The severity of target disease was valued by patients with lower EQ-5D-5L index value as well as URRBMI enrollees.ConclusionsPatients highly valued the health benefits and risks of new technologies, which were closely linked to their feelings of disease and perceptions of health-related quality of life. However, there existed heterogeneity in preferences between URRBMI and UEBMI patients. Further efforts should be made to reduce the gap between insurance schemes and make safe and cost-effective new technologies as a priority for health insurance reimbursement.

scholarly journals Outpatient Visits among Older Adults Living Alone in China: Does Health Insurance and City of Residence Matter?

2020 ◽  
Vol 17 (12) ◽  
pp. 4256
Author(s):  
Jianyun Wang ◽  
Yaolin Pei ◽  
Renyao Zhong ◽  
Bei Wu
Keyword(s):  
Older Adults ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Health Resources ◽  
Medical Insurance ◽  
Urban China ◽  
Living Alone ◽  
Basic Medical Insurance ◽  
Outpatient Visits ◽  
Basic Medical

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.

Undiagnosed and Uncontrolled Chronic Conditions in China: Could Social Health Insurance Consolidation Make a Change?

2017 ◽  
Vol 75 (4) ◽  
pp. 479-515 ◽  
Author(s):  
Xing Lin Feng
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Medical Insurance ◽  
Integrated System ◽  
Noncommunicable Diseases ◽  
Chinese Adults ◽  
Policy Makers ◽  
Basic Medical Insurance ◽  
Cooperative Medical Scheme ◽  
Basic Medical

Policy makers in China are considering consolidating the country’s fragmented health insurance programs. This system consists of three components. The Urban Employee Basic Medical Insurance (UEBMI) covers formal employees, the New Cooperative Medical Scheme (NCMS) covers rural residents, and the Urban Resident Basic Medical Insurance (URBMI) covers urban residents. Consolidation could, in theory, create a more efficient health system that is better able to address noncommunicable diseases. Using national survey data during 2011 to 2013, I found that 44% to 76% cases of hypertension, diabetes, and dyslipidemia went undiagnosed among Chinese adults aged 45 and older. I found that the UEBMI enrollees had a greater number of health checks and 10% higher rates of diagnosis. Assuming that this level of efficiency would be possible under an integrated system, I conducted microsimulation analyses to project future benefits. Such consolidation could result in 46.2 million new diagnoses, and 30.0 million of these cases would be controlled.

scholarly journals Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xian-zhi Fu
Keyword(s):  
Health Insurance ◽  
Financial Risk ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Medical Insurance ◽  
Chinese Government ◽  
Marginal Effect ◽  
Financial Protection ◽  
Basic Medical Insurance ◽  
Basic Medical

Abstract Background After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). Methods We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. Results From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. Conclusions In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.

scholarly journals Costs of hospitalization for chronic kidney disease in Guangzhou, China

2019 ◽  
Vol 22 (2) ◽  
pp. 138-151
Author(s):  
Hui Zhang ◽  
Chao Zhang ◽  
Sufen Zhu ◽  
Feng Zhu ◽  
Yan Wen
Keyword(s):  
Chronic Kidney Disease ◽  
Health Insurance ◽  
Kidney Disease ◽  
Urban Health ◽  
Medical Insurance ◽  
Content Type ◽  
Basic Medical Insurance ◽  
Hospitalization Costs ◽  
The Mean ◽  
Basic Medical

Purpose Chronic kidney disease (CKD) is a worldwide public health problem which imposes a significant financial burden not only on patients but also on the healthcare systems, especially under the pressure of the rapid growth of the elderly population in China. The purpose of this paper is to examine the hospitalization costs of patients with CKD between two urban health insurance schemes and investigate the factors that were associated with their inpatient costs in Guangzhou, China. Design/methodology/approach This was a prevalence-based, observational study using data derived from two insurance claims databases during the period from January 2010 to December 2012 in the largest city, Guangzhou in Southern China. The authors identified 5,803 hospitalizations under two urban health insurance schemes. An extension of generalized linear model – the extended estimating equations approach – was performed to identify the main drivers of total inpatient costs. Findings Among 5,803 inpatients with CKD, the mean age was 60.6. The average length of stay (LOS) was 14.4 days. The average hospitalization costs per inpatient were CNY15,517.7. The mean inpatient costs for patients with Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY15,582.0) were higher than those under Urban Resident-based Basic Medical Insurance (URBMI) scheme (CNY14,917.0). However, the percentage of out-of-pocket expenses for the UEBMI patients (19.8 percent) was only half of that for the URBMI patients (44.5 percent). Insurance type, age, comorbidities, dialysis therapies, severity of disease, LOS and hospital levels were significantly associated with hospitalization costs. Originality/value The costs of hospitalization for CKD were high and differed by types of insurance schemes. This was the first study to compare the differences in hospitalization costs of patients with CKD under two different urban insurance schemes in China. The findings of this study could provide economic evidence for understanding the burden of CKD and evaluating different treatment of CKD (dialysis therapy) in China. Such useful information could also be used by policy makers in health insurance program evaluation and health resources allocation.

Application of digital technologies in health insurance for social good of bottom of pyramid customers in India

2019 ◽  
Vol 39 (9/10) ◽  
pp. 752-772
Author(s):  
Bishwajit Nayak ◽  
Som Sekhar Bhattacharyya ◽  
Bala Krishnamoorthy
Keyword(s):  
Risk Management ◽  
Health Insurance ◽  
Digital Technology ◽  
Social Health Insurance ◽  
Social Health ◽  
Strategic Choices ◽  
Content Type ◽  
Study Results ◽  
The Government ◽  
Health Insurers

Purpose Social health insurance framework of any country is the national identifier of the country’s policy for taking care of its population which cannot access or afford quality healthcare. The purpose of this paper is to highlight the strategic imperatives of digital technology for the inclusive social health models for the BoP customers. Design/methodology/approach A qualitative exploratory study using in-depth personal interviews with 53 Indian health insurance CXOs was conducted with a semi-structured questionnaire. Using MaxQDA software, the interview transcripts were analyzed by means of thematic content analysis technique and patterns identified based on the expert opinions. Findings A framework for the strategic imperatives of digital technology in social health insurance emerged from the study highlighting three key themes for technology implementation in the social health insurance sector – analytics for risk management, cost optimization for operations and enhancement of customer experience. The study results provide key insights about how insurers can enhance the coverage of BoP population by leveraging technology. Social implications The framework would help health insurers and policymakers to select strategic choices related to technology that would enable creation of inclusive health insurance models for BoP customers. Originality/value The absence of specific studies highlighting the strategic digital imperatives in social health insurance creates a unique value proposition for this framework which can help health insurers in developing a convergence in their risk management and customer delight objectives and assist the government in the formulation of a sustainable social health insurance framework.

scholarly journals Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance

2020 ◽  
Vol 17 (17) ◽  
pp. 6327
Author(s):  
Qiang Yao ◽  
Chaojie Liu ◽  
Ju Sun
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Health Insurance Coverage ◽  
Social Health ◽  
Local Health ◽  
Public Health Services ◽  
Internal Migrants ◽  
Use Of Health Services

On-the-spot settlements of medical bills for internal migrants enrolled with a social health insurance program outside of their residential location have been encouraged by the Chinese government, with the intention to improve equality in healthcare services. This study compared the use of health services between the internal migrants who had local health insurance coverage and those who did not. Data (n = 144,956) were obtained from the 2017 China Migrants Dynamic Survey. Use of health services was assessed by two indicators: visits to physicians when needed and registration (shown as health records) for essential public health services. Multi-level logistic regression models were established to estimate the effect size of fund location on the use of health services after controlling for variations in other variables. The respondents who enrolled with a social health insurance scheme locally were more likely to visit physicians when needed (adjusted odds ratio (AOR) = 1.18, 95% CI = 1.06–1.30) and to have a health record (AOR = 1.47, 95% CI = 1.30–1.65) compared with those who enrolled outside of their residential location: a gap of 3.5 percentage points (95% CI: 1.3%–5.8%) and 6.1 percentage point (95% CI: 4.3%–7.8%), respectively. The gaps were larger in the rural-to-urban migrants than those in the urban-to-urban migrants (AOR = 1.17, 95% CI = 0.93–1.48 for visiting physicians when needed; AOR = 0.71, 95% CI = 0.54–0.93 for having a health record). The on-the-spot medical bill settlement system has yet to fully achieve its proposed potential as inequalities in both medical and public health services remain between the internal migrants with and without local health insurance coverage. Further studies are needed to investigate how on-the-spot settlements of medical bills are implemented through coordination across multiple insurance funds.

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