scholarly journals Empirical Analysis of Beneficial Equality of the Basic Medical Insurance for Migrants in China

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Jieying Gao ◽  
Dongxiao Chu ◽  
Tao Ye
Keyword(s):  
Low Income ◽  
Medical Insurance ◽  
Income Group ◽  
Floating Population ◽  
Dynamic Monitoring ◽  
Health Coverage ◽  
Heckman Model ◽  
Basic Medical Insurance ◽  
Income Groups ◽  
Basic Medical

The fairness of the benefits of basic medical insurance for the migrants is drawing increasing attention. This paper examined the beneficial equality of the basic medical insurance for the floating population in China using the “2014 National Internal Migrant Dynamic Monitoring Survey.” The Heckman model was employed due to selection bias among inpatients, and the random forest algorithm of machine learning was used to analyze the importance of factors affecting the hospitalization decision-making, hospitalization consumption, and reimbursement proportion of the floating population. The results show significant differences in the fairness of basic medical insurance benefits among different income groups, and the highest-income group benefits the most. In contrast, the higher-income group benefits the least. Further verification by introducing the commercial medical insurance indicated that the differences among different income groups did not disappear but reduced the degree of difference among the groups. Although China’s healthcare reform has progressed greatly, the study’s findings confirm that the government’s fair medical insurance can lead to unfair problems and the phenomena of low-income groups subsidizing high-income groups under the equalized basic medical insurance system. Adjusting the design of equalized medical insurance and allowing different income groups to pay different premium levels according to the payment level may be more conducive to the fairness of benefits based on achieving universal health coverage in China.

scholarly journals The influence of medical insurance and social security cards on the floating population's settlement intention

2020 ◽  
Author(s):  
Yulin Li ◽  
Lingling Huang ◽  
Li Xiang ◽  
dongmei dou
Keyword(s):  
Social Security ◽  
Social Integration ◽  
Indirect Effect ◽  
Structural Equation ◽  
Medical Insurance ◽  
Floating Population ◽  
Dynamic Monitoring ◽  
Basic Medical Insurance ◽  
The Government ◽  
Basic Medical

Abstract Background There are many studies on the influencing factors of floating population's intention to settle down. Medical insurance and social security cards have an important guarantee for the floating population to live a stable life in the current residence, but there are limited studies focused on the influence of medical insurance and social security cards on their settlement intention. Therefore, the purpose of this paper is to study the influence of medical insurance and social security card on the settlement intention of floating population, so as to create better living and working conditions for floating population and improve their happiness in their current place of residence. Methods Based on the survey data of China's floating population dynamic monitoring in 2017, we explored the influence of medical insurance (urban employee basic medical insurance) and social security cards on the floating population's settlement intention with binary logistic regression and structural equation model. Additionally, this study was also to examine the comprehensive causal relationship, with social integration as the mediator variable. Results The floating population's settlement intention on participating in urban employee basic medical insurance is 23.2 percent higher than those who did not participate. Whether to apply for personal social security cards is related to the settlement intention. The standardized regression coefficients among social insurance and security, social integration, and settlement intention are positive values, and the Z values ​​of the overall effect, indirect effect, and direct effect are all greater than 1.96, and the confidence interval of the indirect effect does not include 0. The article found that this model is a partial intermediary, with an intermediary ratio of 10.66 percent. Conclusions The article highlights the important impact of urban workers' medical insurance and individual social security cards on the floating population. The results of this study may provide some reference for the government to formulate relevant policies.

scholarly journals Inequity under Equality: Research on the Benefits Equity of Chinese Basic Medical Insurance

2020 ◽  
Author(s):  
Li Diao ◽  
Yiwei Liu
Keyword(s):  
Health Care ◽  
Low Income ◽  
Choice Model ◽  
Empirical Test ◽  
Medical Insurance ◽  
High Income ◽  
Mechanism Analysis ◽  
Basic Medical Insurance ◽  
Income Groups ◽  
Basic Medical

Abstract Background: The pursuit of equity is one of the basic principles behind the strengthening of health care reform. China's new rural cooperative medical insurance (NRCMI) and urban residents' basic medical insurance (URBMI) are both “equalized” in terms of fundraising and reimbursement. This paper studies the benefits equity under this "equalized" system.Methods: The data analysed in this paper are from the China Family Panel Studies (CFPS) from 2014 to 2016, implemented by the Institute of Social Science Survey at Peking University. A two-part model and a binary choice model are used in the empirical test.Results: The empirical test revealed that high-income people benefit more from basic medical insurance than low-income people. Mechanism analysis demonstrated that high-income people have higher medical insurance applicability and can utilize better health care. Since low-income people are unhealthier, inequity in benefits exacerbates health inequity. We also found that the benefits equity of URBMI is better than that of NRCMI.Conclusions: The government needs to pay more attention to the issue of medical insurance inequity. We should consider allowing different income groups to pay different premiums according to their medical expenses or applying different reimbursement policies for different income groups.

scholarly journals Inequity under Equality: Research on the Benefits Equity of Chinese Basic Medical Insurance

2020 ◽  
Author(s):  
Li Diao ◽  
Yiwei Liu
Keyword(s):  
Health Care ◽  
Low Income ◽  
Choice Model ◽  
Empirical Test ◽  
Medical Insurance ◽  
High Income ◽  
Mechanism Analysis ◽  
Basic Medical Insurance ◽  
Income Groups ◽  
Basic Medical

Abstract Background: The pursuit of equity is one of the basic principles behind the strengthening of health care reform. China's new rural cooperative medical insurance (NRCMI) and urban residents' basic medical insurance (URBMI) are both “equalized” in terms of fundraising and reimbursement. This paper studies the benefits equity under this "equalized" system.Methods: The data analysed in this paper are from the China Family Panel Studies (CFPS) from 2014 to 2016, implemented by the Institute of Social Science Survey at Peking University. A two-part model and a binary choice model are used in the empirical test.Results: The empirical test revealed that high-income people benefit more from basic medical insurance than low-income people. Mechanism analysis demonstrated that high-income people have higher medical insurance applicability and can utilize better health care. Since low-income people are unhealthier, inequity in benefits exacerbates health inequity. We also found that the benefits equity of URBMI is better than that of NRCMI.Conclusions: The government needs to pay more attention to the issue of medical insurance inequity. We should consider allowing different income groups to pay different premiums according to their medical expenses or applying different reimbursement policies for different income groups.

scholarly journals The influence of medical insurance and social security cards on the floating population's settlement intention

2020 ◽  
Author(s):  
Yulin Li ◽  
Lingling Huang ◽  
Li Xiang ◽  
Dongmei Dou
Keyword(s):  
Social Security ◽  
Social Integration ◽  
Indirect Effect ◽  
Structural Equation ◽  
Medical Insurance ◽  
Floating Population ◽  
Dynamic Monitoring ◽  
Basic Medical Insurance ◽  
The Government ◽  
Basic Medical

Abstract Background: There are many studies on the influencing factors of floating population's intention to settle down. Medical insurance and social security cards have an important guarantee for the floating population to live a stable life in the current residence, but there are limited studies focused on the influence of medical insurance and social security cards on their settlement intention. Therefore, the purpose of this paper is to study the influence of medical insurance and social security card on the settlement intention of floating population, so as to create better living and working conditions for floating population and improve their happiness in their current place of residence. Methods: Based on the survey data of China's floating population dynamic monitoring in 2017, we explored the influence of medical insurance (urban employee basic medical insurance) and social security cards on the floating population's settlement intention with binary logistic regression and structural equation model. Additionally, this study was also to examine the comprehensive causal relationship, with social integration as the mediator variable. Results: The floating population's settlement intention on participating in urban employee basic medical insurance is 23.2 percent higher than those who did not participate. Whether to apply for personal social security cards is related to the settlement intention. The standardized regression coefficients among social insurance and security, social integration, and settlement intention are positive values, and the Z values ​​of the overall effect, indirect effect, and direct effect are all greater than 1.96, and the confidence interval of the indirect effect does not include 0. The article found that this model is a partial intermediary, with an intermediary ratio of 10.66 percent. Conclusions: The article highlights the important impact of urban workers' medical insurance and individual social security cards on the floating population. The results of this study may provide some reference for the government to formulate relevant policies.

scholarly journals Inequity under Equality: Research on the Benefits Equity of Chinese Basic Medical Insurance

2020 ◽  
Author(s):  
Li Diao ◽  
Yiwei Liu
Keyword(s):  
Health Care ◽  
Low Income ◽  
Choice Model ◽  
Empirical Test ◽  
Medical Insurance ◽  
High Income ◽  
Mechanism Analysis ◽  
Basic Medical Insurance ◽  
Income Groups ◽  
Basic Medical

Abstract Background: The pursuit of equity is one of the basic principles behind the strengthening of health care reform. China's new rural cooperative medical insurance (NRCMI) and urban residents' basic medical insurance (URBMI) are both “equalized” in terms of fundraising and reimbursement. This paper studies the benefits equity under this "equalized" system.Methods: The data analysed in this paper are from the China Family Panel Studies (CFPS) from 2014 to 2016, implemented by the Institute of Social Science Survey at Peking University. A two-part model and a binary choice model are used in the empirical test.Results: The empirical test revealed that high-income people benefit more from basic medical insurance than low-income people. Mechanism analysis demonstrated that high-income people have higher medical insurance applicability and can utilize better health care. Since low-income people are unhealthier, inequity in benefits exacerbates health inequity. We also found that the benefits equity of URBMI is better than that of NRCMI.Conclusions: The government needs to pay more attention to the issue of medical insurance inequity. We should consider allowing different income groups to pay different premiums according to their medical expenses or applying different reimbursement policies for different income groups.

scholarly journals Inequity under Equality: Research on the Benefits Equity of Chinese Basic Medical Insurance

2020 ◽  
Author(s):  
Li Diao ◽  
Yiwei Liu
Keyword(s):  
Health Care ◽  
Low Income ◽  
Choice Model ◽  
Empirical Test ◽  
Medical Insurance ◽  
High Income ◽  
Mechanism Analysis ◽  
Basic Medical Insurance ◽  
Income Groups ◽  
Basic Medical

Abstract Background: Insisting on equity is one of the basic principles behind deepening health care reform. China's new rural cooperative medical insurance (NRCMI) and urban residents' basic medical insurance (URBMI) are both “equalized” in fundraising and reimbursement. This paper studies the benefits of equity under such "equalized" system designation. Methods: The data analysed in this paper are from China Family Panel Studies (CFPS) from 2014 to 2016, implemented by the Institute of Social Science Survey at Peking University. A two-part model and a binary choice model are used in the empirical test. Results: An empirical test found that high-income people benefit more from basic medical insurance than low-income people. Mechanism analysis found that high-income people have higher medical insurance applicability and can utilize better health care. Since low-income people are unhealthier, an inequity in benefits will exacerbate health inequity. We also found that the benefits equity of URBMI is better than that of NRCMI. Conclusions: The government needs to pay more attention to the issue of medical insurance inequity. We can consider allowing for different income groups to pay different premiums according to their medical expenses or allowing for different income groups to apply different reimbursement policies.

scholarly journals Are People Enrolled in NCMS and CURBMI Susceptible in Catastrophic Health Expenditure? Evidence From China

2020 ◽  
Vol 57 ◽  
pp. 004695802091928
Author(s):  
Xinpeng Xu ◽  
Hai Gu ◽  
Hua You ◽  
Lan Bai ◽  
Decheng Li ◽  
...  
Keyword(s):  
Low Income ◽  
Health Expenditure ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
New Cooperative Medical Scheme ◽  
Basic Medical Insurance ◽  
Medical Institutions ◽  
Significant Difference ◽  
Cooperative Medical Scheme ◽  
Basic Medical

This study investigated associations between different types of medical insurance and the incidence of catastrophic health expenditure among middle-aged and the aged in China. The data came from the China Health and Retirement Longitudinal Survey implemented in 2013, with 9782 individuals analyzed. Probit regression models and multiple linear regressions were employed to explore the relationship mentioned above and potential mechanisms behind it. It was found that compared with participants in Urban Resident Basic Medical Insurance, individuals participating in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance was less likely to undergo catastrophic health expenditure ( P < .001, P = .008), especially for low-income and middle-income group. Participants in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance were more likely to utilize inpatient medical service ( P < .001, P = .020) and choose low-level medical institutions for treatment ( P = .003, P = .006). And individuals participating in New Cooperative Medical Scheme had lower out-of-pocket expenditure ( P = .034). The study showed the significant difference in the incidence of catastrophic health expenditure among participants in different medical insurances. Efforts should be made to improve the service quality of grassroots medical institutions except for the increase of reimbursement ratio, so that rural residents can enjoy high-quality medical services.

scholarly journals Ten years of progress towards universal health coverage: has China achieved equitable healthcare financing?

2020 ◽  
Vol 5 (11) ◽  
pp. e003570
Author(s):  
Mingsheng Chen ◽  
Guoliang Zhou ◽  
Lei Si
Keyword(s):  
Medical Insurance ◽  
Horizontal Equity ◽  
Health Coverage ◽  
Healthcare Financing ◽  
Financing System ◽  
Basic Medical Insurance ◽  
The Poor ◽  
The Rich ◽  
Universal Health ◽  
Basic Medical

IntroductionThis study aims to systematically evaluate vertical and horizontal equity in the Chinese healthcare financing system over the period 2008–2018 during the progress towards Universal Health Coverage (UHC), and to examine how both types of equity have changed during this period.MethodsHousehold information on healthcare payments was collected from 2398 households involving 7021 individuals in 2008, 3600 households involving 10 466 individuals in 2013 and 3660 households involving 11 550 individuals in 2018. Redistributive effects of healthcare financing system were decomposed into progressivity, pure horizontal inequity and reranking. Progressivity analysis and the Aronson-Johnson-Lambert decomposition method were adopted to measure the vertical equity and horizontal equity of healthcare financing.ResultsOver the period 2008–2018, healthcare financing through indirect taxes showed a slightly prorich structure and healthcare financing through direct taxes showed a propoor structure in both urban and rural areas. Urban Employee Basic Medical Insurance experienced redistribution from the poor to the rich during the period 2008–2013, but then experienced redistribution from the rich to the poor during the period 2013–2018. Urban Resident Basic Medical Insurance (URBMI), New Rural Cooperative Medical Scheme (NRCMS), Urban and Rural Resident Basic Medical Insurance (URRBMI) and out-of-pocket payments experienced redistribution from the poor to the rich over the entire period.ConclusionChina’s healthcare financing has experienced redistribution from the poor to the rich during 10 years of progress toward the UHC. UHC improved access to and utilisation of healthcare in urban areas. The flat rate contribution mechanism should be renovated for URBMI, NRCMS and URRBMI.

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 An Empirical Study on the Benefits Equity of the Medical Security Policy: the China Health and Nutrition Survey (CHNS)

2020 ◽  
Vol 17 (4) ◽  
pp. 1203 ◽  
Author(s):  
Huan Liu ◽  
Weidong Dai
Keyword(s):  
Health Care ◽  
Medical Insurance ◽  
Preventive Health Care ◽  
Income Group ◽  
Preventive Health ◽  
Medical Assistance ◽  
Middle Income ◽  
Basic Medical Insurance ◽  
Medical Security ◽  
Basic Medical

Background: One of the fundamental objectives of the basic medical security system is to provide institutional guarantees for the appropriate medical needs of different groups. Among them, achieving fairness of benefits is the first principle of the system. This study aims to explore the benefit equity of preventive health care for different groups and the specific path to promote fairness. Methods: Based on the 2015 CHNS survey data, through the theory construction of benefit fairness in the basic medical insurance and using the two-stage IV-Heckman model, the paper analyzes the benefit fairness of the basic medical insurance in urban and rural China. Results: This study indicates that (1) the results of empirical and theoretical models are not consistent with the sample of the insured population. (2) As private medical insurance and medical assistance are restricted in the model, the reimbursement ratio of medical insurance in other income groups is all higher than the highest one. However, the coefficient is getting larger, with the lowest income group having the largest coefficient. After controlling for variables of disease and severity, the results suggest that the main impact path is hospitalization costs. (3) Taking the highest income group as a reference, the compensation proportion of preventive health care in other groups is higher, respectively, than the reference group, while the groups below middle income have a significant relationship with compensation for preventive health care. Conclusions: Supplementary private medical insurance and medical assistance have important protection functions for low- and middle-income populations. However, owing to the actual income threshold, the two groups cannot benefit from the medical security system. This result is still valid in the field of preventive health care. The increase of preventive health care expenditure reduces the cost of individual hospitalization, but the high-income group has emerged with more preventive health care expenditures, creating new unfairness.

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