Examining children’s health equity under the Chinese basic medical insurance system: A comparison between the United States and Mainland China

This article describes and examines the newly implemented basic medical insurance system for urban employees in China. The insurance system was built on two distinct concepts, individual providence and social insurance, and was characterized by national government mandates, local government administration, and employer/employee contributions. The study found that the Chinese basic medical insurance program for urban employees was implemented in all major urban areas. About 130 million people were covered under the scheme as of May 2005. The program benefits are limited with relatively low ceilings on reimbursable expenses and high cost sharing from the insured. The procedure for reimbursement is complicated and time consuming. China can learn from the U.S. and Canadian systems in both financing and providing healthcare. The U.S. system arguably supplies the best medical services in terms of quality and accessibility for those who are insured and those who can pay out of pocket. But the huge costs may not work well with China at present. The Canadian system, which is relatively effective, efficient, and equitable, although not as accessible, may fit China better. The study also suggests that the U.S. employer-based healthcare insurance system requires a major overhaul. It puts U.S. companies at a disadvantaged position in the increasingly competitive global marketplace.

Download Full-text

Prevalence of Extramammary Paget's Disease in Urban China: A Population-based Study

10.21203/rs.3.rs-48451/v1 ◽

2020 ◽

Author(s):

Shilu Yin ◽

Lu Xu ◽

Shengfeng Wang ◽

Jingnan Feng ◽

Lili Liu ◽

...

Keyword(s):

Paget’S Disease ◽

Medical Insurance ◽

The United States ◽

Population Based ◽

Paget's Disease ◽

Extramammary Paget’S Disease ◽

Population Based Study ◽

Basic Medical Insurance ◽

Basic Medical ◽

Extramammary Paget's Disease

Abstract Background Extramammary Paget’s disease (EMPD) is an intraepithelial adenocarcinoma. The chronic relapsing clinical course and unbearable clinical symptoms of EMPD usually result in a markedly diminished quality of life. No national data are available on descriptive epidemiology of EMPD in China, the most populous country over the world. This population-based study aimed to estimate the prevalence and associated sex and age patterns of EMPD in China. Methods This study was conducted using data from China’s Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance, covering approximately 0.43 billion Chinese urban residents in 2016. Patients with EMPD were identified based on the diagnostic names and codes in claim data. Results A total of 53 males and 31 females with EMPD were found. The crude prevalence in 2016 was 0.04 per 100 000 population [95% confidence interval (CI): 0.02 to 0.06], ranging from 0.01 (95% CI: 0.00 to 0.02) in North or Northeast China to 0.08 (95% CI: 0.03 to 0.16) in Southwest China. The rates were higher in males (0.05, 95% CI: 0.03 to 0.08) compared with females (0.03, 95% CI: 0.02 to 0.05). The mean age of patients was 65.87 (standard deviation: 14.21) years, with the peak prevalence appeared in patients aged 70–79 (0.28, 95% CI: 0.16 to 0.42). Conclusions The prevalence of EMPD was markedly lower than those in the United States and Europe, and varied across regions in China. Chinese patients were much younger, with significant male predominance. Further study is warranted to examine potential pathophysiologic mechanism.

Download Full-text

A Study of Healthcare Reform in China in Light of the USA and Canadian Systems

Chinese Public Administration Review ◽

10.22140/cpar.v10i2.203 ◽

2019 ◽

Vol 10 (2) ◽

pp. 18

Author(s):

Greg Chen

Keyword(s):

Urban Areas ◽

Social Insurance ◽

Medical Insurance ◽

Global Marketplace ◽

Insurance System ◽

Basic Medical Insurance ◽

Government Mandates ◽

The Usa ◽

The U.S ◽

Basic Medical

This article describes and examines the newly implemented basic medical insurance system for urban employees in China. The insurance system was built on two distinct concepts, individual providence and social insurance, and was characterized by national government mandates, local government administration, and employer/employee contributions. The study found that the Chinese basic medical insurance program for urban employees was implemented in all major urban areas. About 130 million people were covered under the scheme as of May 2005. The program benefits are limited with relatively low ceilings on reimbursable expenses and high cost sharing from the insured. The procedure for reimbursement is complicated and time consuming. China can learn from the U.S. and Canadian systems in both financing and providing healthcare. The U.S. system arguably supplies the best medical services in terms of quality and accessibility for those who are insured and those who can pay out of pocket. But the huge costs may not work well with China at present. The Canadian system, which is relatively effective, efficient, and equitable, although not as accessible, may fit China better. The study also suggests that the U.S. employer-based healthcare insurance system requires a major overhaul. It puts U.S. companies at a disadvantaged position in the increasingly competitive global marketplace.

Download Full-text

Study on the emergency mechanism of Chinese basic medical insurance system and its management informatization

2011 IEEE International Symposium on IT in Medicine and Education ◽

10.1109/itime.2011.6132079 ◽

2011 ◽

Author(s):

Shen Ruo-qian

Keyword(s):

Medical Insurance ◽

Insurance System ◽

Basic Medical Insurance ◽

Basic Medical

Download Full-text

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15102159 ◽

2018 ◽

Vol 15 (10) ◽

pp. 2159 ◽

Cited By ~ 7

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.

Download Full-text

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

BMJ Open ◽

10.1136/bmjopen-2020-040437 ◽

2020 ◽

Vol 10 (10) ◽

pp. e040437 ◽

Cited By ~ 1

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.

Download Full-text

Greater inequalities in dental caries treatment than in caries experience: a concentration index decomposition approach

BMC Oral Health ◽

10.1186/s12903-021-01935-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuandong Qin ◽

Lin Chen ◽

Jianbo Li ◽

Yunyun Wu ◽

Shaohong Huang

Keyword(s):

Oral Health ◽

Low Income ◽

Household Income ◽

Medical Insurance ◽

Caries Experience ◽

Insurance System ◽

Basic Medical Insurance ◽

New Type ◽

Concentration Indices ◽

Basic Medical

Abstract Background The aim of the current study was to (a) measure the socioeconomic inequalities in oral health and examine whether the inequalities are greater in disease experience or in its treatment and to (b) decompose the factors that influence oral health inequalities among the adults of Guangdong Province. Methods A cross-sectional study was conducted among 35- to 44-year-old and 65- to 74-year-old adults in Guangdong Province. All participants underwent oral health examinations and answered questionnaires about their oral health. We measured the concentration indices of the DMFT and its separate components, namely, decayed teeth (DT), missing teeth (MT), and filled teeth (FT), to explore the inequalities in oral health status; then, we analysed its decomposition to interpret the factors that influence the inequalities. Results The results showed that significant inequality was concentrated on FT (CI = 0.24, 95% CI = 0.14/0.33, SE = 0.05). The concentration indices for the DMFT (CI = 0.02, 95% CI = 0.02/0.06, SE = 0.02) and MT (CI = 0.02, 95% CI 0.03/0.08, SE = 0.03) were small and close to zero, while the concentration for DT (CI = − 0.04, 95% CI = − 0.01/0.02, SE = 0.03) was not statistically significant. The results from the decomposition analysis suggested that a substantial proportion of the inequality was explained by household income, high education level, regular oral examination and type of insurance (5.1%, 12.4%, 43.2%, − 39.6% (Urban Employee Basic Medical Insurance System) and 34.5% (New-Type Rural Medical Collaboration System), respectively). Conclusions The results indicated greater inequalities in dental caries than in caries experience. Among the included factors, household income, high education level, and regular oral health examinations had the greatest impact on the inequalities in the number of FT. In addition, the current medical insurance systems, including the Urban Employee Basic Medical Insurance System, Urban Resident Basic Medical Insurance System, and the New-Type Rural Medical Collaboration System, have not been effectively used in oral treatment. Policy-making and the implementation of interventions for tackling socioeconomic oral health inequalities should focus on reducing the burden of treatment and providing greater access to dental care for low-income groups. Welfare policies are skewed towards rural areas and low-income people.

Download Full-text

Prevalence of extramammary Paget’s disease in urban China: a population-based study

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01715-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Shilu Yin ◽

Lu Xu ◽

Shengfeng Wang ◽

Jingnan Feng ◽

Lili Liu ◽

...

Keyword(s):

Paget’S Disease ◽

Medical Insurance ◽

The United States ◽

Population Based ◽

Paget's Disease ◽

Extramammary Paget’S Disease ◽

Population Based Study ◽

Basic Medical Insurance ◽

Basic Medical ◽

Extramammary Paget's Disease

Abstract Background Extramammary Paget’s disease (EMPD) is an intraepithelial adenocarcinoma. The chronic relapsing clinical course and unbearable clinical symptoms of extramammary Paget’s disease usually result in a markedly diminished quality of life. No national data are available on descriptive epidemiology of EMPD in China, the most populous country over the world. This population-based study aimed to estimate the prevalence and associated sex and age patterns of EMPD in China. Methods This study was conducted using data from China’s Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance, covering approximately 0.43 billion Chinese urban residents in 2016. Patients with EMPD were identified based on the diagnostic names and codes in claim data. Results A total of 53 males and 31 females with EMPD were found. The crude prevalence in 2016 was 0.04 per 100,000 population [95% confidence interval (CI) 0.02–0.06], ranging from 0.01 (95% CI 0.00–0.02) in North or Northeast China to 0.08 (95% CI 0.03–0.16) in Southwest China. The rate was higher in males (0.05, 95% CI 0.03–0.08) compared with females (0.03, 95% CI 0.02–0.05). The mean age of patients was 65.87 (standard deviation: 14.21) years, with the peak prevalence appeared in patients aged 70–79 (0.28, 95% CI 0.16–0.42). Conclusions The prevalence of EMPD was markedly lower than those in the United States and Europe, and varied across regions in China. Chinese patients were much younger, with significant male predominance. Further studies are warranted to examine potential pathophysiologic mechanism.

Download Full-text