scholarly journals Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040437 ◽  
Author(s):  
Yong Yang ◽  
Xiaowei Man ◽  
Stephen Nicholas ◽  
Shuo Li ◽  
Qian Bai ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Outcome Measures ◽  
Medical Insurance ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Research Association ◽  
Insurance System ◽  
Basic Medical Insurance ◽  
Basic Medical

ObjectivesThis study investigates the disparities in the utilisation of patient health services for patients who had a stroke covered by different urban basic health insurance schemes in China.DesignWe conducted descriptive analysis based on a 5% random sample from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) in 2015, supplied by the China Health Insurance Research Association.SettingChinese urban social insurance system.ParticipantsA total of 56 485 patients who had a stroke were identified, including 36 487 UEBMI patients and 19 998 URBMI patients.Primary and secondary outcome measuresThe primary outcome measures include annual number of hospitalisations, average length of stay (ALOS) and average hospitalisation cost. Out-of-pocket (OOP) cost is the secondary outcome measure.ResultsThe annual mean number of hospitalisations of UEBMI patients was 1.21 and 1.15 for URBMI patients. The ALOS was significantly longer for UEBMI than for URBMI patients (13.93 vs 10.82, p<0.001). Hospital costs were significantly higher for UEBMI than for URBMI patients (US$1724.02 vs US$986.59 (p<0.001), while the OOP costs were significantly higher for URBMI than for UEBMI patients (US$423.17 vs US$407.81 (p<0.001). Patients with UEBMI had higher reimbursement rate than URBMI patients (79.41% vs 66.92%, p<0.001) and a lower self-paid ratio than URBMI patients (23.65% vs 42.89%, p<0.001).ConclusionsSignificant disparities were found in the utilisation of hospital services between UEBMI and URBMI patients. Our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gaps in China’s health insurance schemes.

scholarly journals Disparities in the utilization of ischemic stroke inpatient services in China: the role of urban basic health insurance

2019 ◽  
Author(s):  
Yong yang ◽  
Xiaowei Man ◽  
Shuo Li ◽  
Qian Bai ◽  
Peiwen Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Health Insurance ◽  
Health Services ◽  
Medical Insurance ◽  
Research Association ◽  
Insurance Scheme ◽  
Hospitalization Cost ◽  
Basic Medical Insurance ◽  
Basic Medical ◽  
Out Of Pocket Costs

Abstract Background As one major disease threatening human health, stroke has placed a heavy financial burden on patients worldwide. This study aims to confirm whether there are disparities and inequity in the utilization of inpatient health services for stroke inpatients covered by different health insurance schemes. Methods We conducted statistical analysis based on the data containing urban employee-based basic medical insurance scheme (UEBMI) and urban resident-based basic medical insurance scheme (URBMI) groups, supplied by the China Health Insurance Research Association (CHIRA). Descriptive analysis was the main method to finish this analysis. Results Of the 56485 inpatients who had been diagnosed with ischemic stroke, extracted from the CHIRA claimed database, 64.6% (36487) were covered by UEBMI and 35.4% (19998) were covered by URBMI; the mean age of UEBMI subgroup was slightly older than URBMI subgroup (68.64 and 67.45 years old). The annual frequency of hospitalization of UEBMI subgroup was 1.21 times and 1.15 times for URBMI subgroup. The average length of stay of UEBMI subgroup(13.93days) was longer than URBMI subgroup (10.82 days). The UEBMI group had a higher hospitalization costs but fewer out-of-pocket costs: for the UEBMI subgroup, the average hospitalization cost was RMB11187.64($1724.02), the average total out-of-pocket costs was RMB2646.42($407.81). While for the URBMI subgroup, the average hospitalization cost was RMB6402.27($986.59) and the average total out-of-pocket costs was RMB2746.10($423.17). All the above differences were significant(P<0.001). Meanwhile, patients with UEBMI had higher reimbursement rate (82.65% and 63.82%). Conclusions We found that there were nonnegligible disparities in the utilization of inpatient health services between UEBMI and URBMI as well as health inequity and financial protection inequity. Thus, our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gap in health insurance schemes in China.

scholarly journals Disparities in the utilization of ischemic stroke inpatient services in China: the role of urban health insurance

2020 ◽  
Author(s):  
Yong Yang ◽  
Xiaowei Man ◽  
Stephen Nicholas ◽  
Shuo Li ◽  
Qian Bai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Health Insurance ◽  
Health Services ◽  
Medical Insurance ◽  
Research Association ◽  
Insurance Scheme ◽  
Hospitalization Cost ◽  
Basic Medical Insurance ◽  
Basic Medical ◽  
Out Of Pocket Costs

Abstract Background: As the second most common cause of death globally, strokes impose a significant financial burden on patients and a country’s health system. This study demonstrates the disparities in the utilization of inpatient health services for stroke patients covered by different urban basic health insurance schemes in China.Methods: We conducted statistical analysis based on the data containing urban employee-based basic medical insurance scheme (UEBMI) and urban resident-based basic medical insurance scheme (URBMI) groups, supplied by the China Health Insurance Research Association (CHIRA). Descriptive analysis was the main method to finish this study.Results: Of the inpatients (N=56485) who had been diagnosed with ischemic stroke, extracted from the CHIRA claimed database, 64.6% (36487) were covered by UEBMI and 35.4% (19998) were covered by URBMI. The annual frequency of hospitalization of UEBMI subgroup was 1.21 times and 1.15 times for URBMI subgroup. The average length of stay of UEBMI subgroup(13.93days) was longer than URBMI subgroup (10.82 days). The UEBMI group had higher hospitalization costs but fewer out-of-pocket costs: for the UEBMI subgroup, the average hospitalization cost was RMB11187.64($1724.02), the average total out-of-pocket costs was RMB2646.42($407.81). While for the URBMI subgroup, the average hospitalization cost was RMB6402.27($986.59) and the average total out-of-pocket costs was RMB2746.10($423.17). All the above differences were significant(P<0.001). Meanwhile, patients with UEBMI had higher reimbursement rate (82.65% and 63.82%) and lower self-paid ratio (23.65% and 42.89%).Conclusions: We found that there were nonnegligible disparities in the utilization of inpatient health services between UEBMI and URBMI. Thus, our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gap in health insurance schemes in China.

scholarly journals The Impact of Health Insurance Policy on the Health of the Senior Floating Population—Evidence from China

2018 ◽  
Vol 15 (10) ◽  
pp. 2159 ◽  
Author(s):  
Yingying Meng ◽  
Junqiang Han ◽  
Siqi Qin
Keyword(s):  
Health Insurance ◽  
Instrumental Variable ◽  
Academic Research ◽  
Medical Insurance ◽  
Floating Population ◽  
Insurance System ◽  
Self Rated Health ◽  
Basic Medical Insurance ◽  
The Impact ◽  
Basic Medical

The impact of health insurance on residents’ health is one of the focal points of academic research. Due to the fact that China’s medical insurance system is composed of a variety of programs and that the pooling districts are at the lower administrative level, enrollment in different medical insurance programs or at different places may have certain influences on the health of residents. This has mostly been neglected by previous studies. This paper uses data from the 2015 China Migrants Dynamic Survey (CMDS), focusing on the senior floating population and taking the difference in government subsidy proportions as an instrumental variable in order to identify the effects of health insurance programs and regional differences on the health of the senior floating population. Three effects were observed: First, participation in the health insurance system significantly improves floating seniors’ self-rated health. Second, the health status of floating seniors affects their choice of health insurance program: Less healthy persons tend to choose high-paying, wide-coverage basic medical insurance available for urban employees. Using an instrumental variable to control for the problem of endogeneity, it is discovered that compared with the basic medical insurance system for urban residents, the system for urban employees significantly enhances the health of the senior floating population. Third, “adverse selection” could be observed in the choice between enrolling in health insurance at the place of settlement or another place. Senior migrants with worse self-rated health tend to choose place of settlement in order to enjoy higher compensation and less complex reimbursement procedures. With an instrumental variable to control for the problem of endogeneity, it was found that compared with joining the medical insurance system at other places, joining at a place of settlement could improve the health of the floating senior population.

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.

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.

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