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.

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 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 Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinsong Geng ◽  
Xiaowei Chen ◽  
Jianwei Shi ◽  
Haini Bao ◽  
Qian Chen ◽  
...  
Keyword(s):  
Health Insurance ◽  
Chronic Diseases ◽  
Structural Equation ◽  
Insurance Coverage ◽  
Perceived Value ◽  
Health Insurance Coverage ◽  
Equation Modeling ◽  
Basic Medical Insurance ◽  
Degree Of Satisfaction ◽  
Basic Medical

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.

scholarly journals Varying Opinions on Who Deserves Collectively Financed Health Care Services: A Discrete Choice Experiment on Allocation Preferences of the General Public

2018 ◽  
Vol 55 ◽  
pp. 004695801775198
Author(s):  
Maartje J. van der Aa ◽  
Aggie T. G. Paulus ◽  
Mickaël J. C. Hiligsmann ◽  
Johannes A. M. Maarse ◽  
Silvia M. A. A. Evers
Keyword(s):  
Health Care ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
General Public ◽  
Choice Experiment ◽  
Access To Health Care ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Financial Capacity ◽  
Medical Needs

In Europe, health insurance arrangements are under reform. These arrangements redistribute collectively financed resources to ensure access to health care for all. Allocation of health services is historically based on medical needs, but use of other criteria, such as lifestyle, is debated upon. Does the general public also have preferences for conditional allocation? This depends on their opinions regarding deservingness. The aim of this study was to gain insight in those opinions, specifically by examining the perceived weight of different criteria in allocation decisions. Based on literature and expert interviews, we included 5 criteria in a discrete choice experiment: need, financial capacity, lifestyle, cooperation with treatment, and package/premium choice. A representative sample of the Dutch population was invited to participate (n = 10 760). A total of 774 people accessed the questionnaire (7.2%), of whom 375 completed it (48.4%). Medical need was overall the most important criterion in determining deservingness (range β = 1.60). Perceived deservingness decreased if claimants had higher financial capacity (1.26) and unhealthier lifestyle (1.04), if their cooperation was less optimal (1.05), or if they had opted for less insurance coverage (0.56). However, preferences vary among respondents, in relation to demographic and ideological factors.

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 Developing attributes and levels for a discrete choice experiment on basic health insurance in Iran

2018 ◽  
Vol 32 (1) ◽  
pp. 142-150 ◽  
Author(s):  
Ali Kazemi Karyani ◽  
Arash Rashidian ◽  
Ali Akbari Sari ◽  
Sara Emamgholipour Sefiddashti
Keyword(s):  
Health Insurance ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Basic Health Insurance ◽  
Basic Health
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