Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China

Abstract Background The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China. Methods The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization. Results The integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011. Conclusions The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.

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Health care utilization for patients with stroke: a 3-year cross-sectional study of China’s two urban health insurance schemes across four cities

BMC Public Health ◽

10.1186/s12889-021-10456-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yong Yang ◽

Stephen Nicholas ◽

Shuo Li ◽

Zhengwei Huang ◽

Xiaoping Chen ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Length Of Stay ◽

Health Care Utilization ◽

Medical Costs ◽

Care Utilization ◽

Stroke Patients ◽

Basic Medical Insurance ◽

Insurance Type ◽

Basic Medical

Abstract Background Stroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in stroke patients’ health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China. Methods A 5% random sample from the 2014–2016 China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data. Results We found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMI patients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMI patients had significantly higher outpatient medical costs (RMB356.9) than URBMI patients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: − 0.672, − 0.649) fewer outpatient visits, 13.0% (95% CI: − 0.144, − 0.115) fewer inpatient visits, and 34.2% (95% CI: − 0.366, − 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference. Conclusions Significant city-specific differences in stroke patients’ healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of stroke patient access to health care.

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Chronic Physical Effects and Health Care Utilization in Long-Term Ovarian Germ Cell Tumor Survivors: A Gynecologic Oncology Group Study

Journal of Clinical Oncology ◽

10.1200/jco.2008.20.9189 ◽

2009 ◽

Vol 27 (25) ◽

pp. 4142-4149 ◽

Cited By ~ 30

Author(s):

Daniela Matei ◽

Anna M. Miller ◽

Patrick Monahan ◽

David Gershenson ◽

Qianqian Zhao ◽

...

Keyword(s):

Health Care ◽

Hearing Loss ◽

Health Insurance ◽

Health Care Utilization ◽

Germ Cell ◽

Germ Cell Tumor ◽

Cell Tumor ◽

Care Utilization ◽

Control Group ◽

Gynecologic Oncology Group

Purpose This study compares late effects of treatment on physical well-being and utilization of health care resources between ovarian germ cell tumor (OGCT) survivors and age/race/education-matched controls. Patients and Methods Eligible patients had OGCT treated with surgery and chemotherapy and were disease-free for at least 2 years at time of enrollment. The matched control group was selected from acquaintances recommended by survivors. Symptoms and function were measured using previously validated scales. Health care utilization was assessed by questions regarding health insurance coverage and health services utilization. Results One hundred thirty-two survivors and 137 controls completed the study. Survivors were significantly more likely to report a diagnosis of hypertension (17% v 8%, P = .02), and marginally hypercholesterolemia (9.8% v 4.4%, P = .09), and hearing loss (5.3% v 1.5%, P = .09) compared with controls. There were no significant differences in the rates of self-reported arthritis, heart, pulmonary or kidney disease, diabetes, non-OGCT malignancies, anxiety, hearing loss, or eating disorders between groups. Among chronic functional problems, numbness, tinnitus, nausea elicited by reminders of chemotherapy (v general nausea triggers for controls), and Raynaud's symptoms were reported more frequently by survivors. Patients who received vincristine, dactinomycin, and cyclophosphamide in addition to cisplatin therapy had increased functional complaints, particularly numbness and nausea. Health care utilization was similar, but 15.9% of survivors reported being denied health insurance versus 4.4% of controls (P < .001). Conclusion Although a few sequelae of treatment persist, in general, OGCT survivors enjoy a healthy life comparable to that of controls.

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The effect of shifting medical coverage from National Health Insurance to Medical Aid type I and type II on health care utilization and out-of-pocket spending in South Korea

BMC Health Services Research ◽

10.1186/s12913-020-05778-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Doo Woong Lee ◽

Jieun Jang ◽

Dong-Woo Choi ◽

Sung-In Jang ◽

Eun-Cheol Park

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Utilization ◽

National Health Insurance ◽

National Health ◽

Care Utilization ◽

Type I ◽

Type Ii ◽

Medical Aid ◽

Outpatient Visits

Abstract Background This study examines the effects of a shift in medical coverage, from National Health Insurance (NHI) to Medical Aid (MA), on health care utilization (measured by the number of outpatient visits and length of stay; LOS) and out-of-pocket medical expenses. Methods Data were collected from the Korean Welfare Panel Study (2010–2016). A total of 888 MA Type I beneficiaries and 221 MA Type II beneficiaries who shifted from the NHI were included as the case group and 2664 and 663 consecutive NHI holders (1:3 propensity score-matched) were included as the control group, respectively. We used the ‘difference-in-differences’ (DiD) analysis approach to assess changes in health care utilization and medical spending by the group members. Results Differential average changes in outpatient visits in the MA Type I panel between the pre- and post-shift periods were significant, but differential changes in LOS were not found. Those who shifted from NHI to MA Type I had increased number of outpatient visits without changes in out-of-pocket spending, compared to consecutive NHI holder who had similar characteristics. However, this was not found for MA Type II beneficiaries. Conclusion Our research provides evidence that the shift in medical coverage from NHI to MA Type I increased the number of outpatient visits without increasing the out-of-pocket spending. Considering the problem of excess medical utilization by Korean MA Type I beneficiaries, further researches are required to have in-depth discussions on the appropriateness of the current cost-sharing level on MA beneficiaries.

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Health care utilization for patients with stroke: A 3-year cross-sectional study of China’s two urban health insurance schemes across four cities

10.21203/rs.3.rs-37086/v1 ◽

2020 ◽

Author(s):

Yong Yang ◽

Stephen Nicholas ◽

Shuo Li ◽

Zhengwei Huang ◽

Xiaoping Chen ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Healthcare Utilization ◽

Average Length ◽

Medical Insurance ◽

Medical Costs ◽

Care Utilization ◽

Basic Medical Insurance ◽

Insurance Type ◽

Basic Medical

Abstract Background Stroke is a devastating disease and a major cause of death and disability worldwide. We evaluated differences in stroke patients’ health care utilization by insurance type across four cities in China. Methods The data were a 5% random sampling from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) from 2014 to 2016. The descriptive analyze and interaction actions were mainly conducted. Results We found that differences in healthcare utilization and medical expenses varied more across the four cities, Beijing, Shanghai, Tianjin, and Chongqing, than they did between the UEBMI and URBMI scheme. On average, UEBMI patients had a significantly larger number of outpatient (4.3) and inpatient (1.4) visits per year than the URBMI group (2.0 outpatient and 1.1 inpatient visits per year). UEBMI members’ average length of stay (ALOS) of 18.3 days was significantly longer than the 11 days ALOS of URBMI members. Importantly, the significant differences in healthcare utilization and healthcare expenditures were greater between cities than the average differences between UEBMI and URBMI. Beijing UEBMI outpatient (5.0) and inpatient (1.4) visits and Shanghai UEBMI outpatient (4.8) and inpatient (1.7) visits were significantly higher than Tianjin (3.4 outpatient and 1.4 inpatient visits) and Chongqing (1.8 outpatient and 1.1 inpatient visits). The divergences of UEBMI visits across the four cities were greater than the average UEBMI outpatient (4.3) and inpatient (1.4) visits. ALOS for URBMI Beijing patients (14.8 days) and Shanghai patients (27.7 days) were significantly longer than Tianjin (10.2 days) and Chongqing (10.1 days) URBMI patients. Medical costs, total OOP expenses and OOP reimbursement rates also varied more across the four cities than the average UEBMI or URBMI medical costs, total OOP expenses and reimbursement rates. Conclusions The health care utilization of patients with stroke varied by insurance type and city, and the differences in utilization and health care costs across cities was greater than the average difference between UEBMI and URBMI. Launching a new critical illness insurance scheme and further reforming the UEBMI and URBMI schemes would reduce these inter-city differences in health care utilization.

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Impact of China's Urban Resident Basic Medical Insurance on Health Care Utilization and Expenditure

SSRN Electronic Journal ◽

10.2139/ssrn.2157910 ◽

2012 ◽

Author(s):

Hong Liu ◽

Zhong Zhao

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Medical Insurance ◽

Care Utilization ◽

Urban Resident ◽

Basic Medical Insurance ◽

Basic Medical

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Health Care Utilization in Rural Senegal: What can We Expect from the Extension of Health Insurance to Farming Households?

SSRN Electronic Journal ◽

10.2139/ssrn.1965752 ◽

2011 ◽

Cited By ~ 1

Author(s):

Aurelia Lepine ◽

Alexis Le Nestour

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Utilization ◽

Care Utilization ◽

Farming Households

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Burden of Behavioral Health Comorbidities on Outpatient Health Care Utilization by Active Duty Service Members With a First Documented mTBI

Military Medicine ◽

10.1093/milmed/usaa320 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 567-571

Author(s):

Lalon M Kasuske ◽

Peter Hoover ◽

Tim Wu ◽

Louis M French ◽

Jesus J Caban

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Behavioral Health ◽

Active Duty ◽

Service Members ◽

Care Utilization ◽

Men And Women ◽

Outpatient Visits ◽

Outpatient Utilization ◽

Health Comorbidities

ABSTRACT Objective More than 280,000 Active Duty Service Members (ADSMs) sustained a mild traumatic brain injury (mTBI) between 2000 and 2019 (Q3). Previous studies of veterans have shown higher utilization of outpatient health clinics by veterans diagnosed with mTBI. Additionally, veterans with mTBI and comorbid behavioral health (BH) conditions such as post-traumatic stress disorder, depression, and substance use disorders have significantly higher health care utilization than veterans diagnosed with mTBI alone. However, few studies of the relationship between mTBI, health care utilization, and BH conditions in the active duty military population currently exist. We examined the proportion of ADSMs with a BH diagnosis before and after a first documented mTBI and quantified outpatient utilization of the Military Health System in the year before and following injury. Materials and Methods Retrospective analysis of 4,901,840 outpatient encounters for 39,559 ADSMs with a first documented diagnosis of mTBI recorded in the Department of Defense electronic health record, subsets of who had a BH diagnosis. We examined median outpatient utilization 1 year before and 1 year after mTBI using Wilcoxon signed rank test, and the results are reported with an effect size r. Outpatient utilization is compared by BH subgroups. Results Approximately 60% of ADSMs experience a first mTBI with no associated BH condition, but 17% of men and women are newly diagnosed with a BH condition in the year following mTBI. ADSMs with a history of a BH condition before mTBI increased their median outpatient utilization from 23 to 35 visits for men and from 32 to 42 visits for women. In previously healthy ADSMs with a new BH condition following mTBI, men more than tripled median utilization from 7 to 24 outpatient visits, and women doubled utilization from 15 to 32 outpatient visits. Conclusions Behavioral health comorbidities affect approximately one-third of ADSMs following a first mTBI, and approximately 17% of previously healthy active duty men and women will be diagnosed with a new BH condition in the year following a first mTBI. Post-mTBI outpatient health care utilization is highly dependent on the presence or absence of BH condition and is markedly higher is ADSMs with a BH diagnosis in the year after a first documented mTBI.

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A Comparison Between Subjective and Objective Methods of Predicting Health Care Expenses to Support Consumers’ Health Insurance Plan Choice

MDM Policy & Practice ◽

10.1177/2381468318781093 ◽

2018 ◽

Vol 3 (1) ◽

pp. 238146831878109 ◽

Cited By ~ 1

Author(s):

Mary C. Politi ◽

Enbal Shacham ◽

Abigail R. Barker ◽

Nerissa George ◽

Nageen Mir ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Utilization ◽

Subjective Health ◽

Care Utilization ◽

Insurance Plan ◽

Health Insurance Plan ◽

Subjective Health Status ◽

Reported Health ◽

Nationally Representative

Objective. Numerous electronic tools help consumers select health insurance plans based on their estimated health care utilization. However, the best way to personalize these tools is unknown. The purpose of this study was to compare two common methods of personalizing health insurance plan displays: 1) quantitative healthcare utilization predictions using nationally representative Medical Expenditure Panel Survey (MEPS) data and 2) subjective-health status predictions. We also explored their relations to self-reported health care utilization. Methods. Secondary data analysis was conducted with responses from 327 adults under age 65 considering health insurance enrollment in the Affordable Care Act (ACA) marketplace. Participants were asked to report their subjective health, health conditions, and demographic information. MEPS data were used to estimate predicted annual expenditures based on age, gender, and reported health conditions. Self-reported health care utilization was obtained for 120 participants at a 1-year follow-up. Results. MEPS-based predictions and subjective-health status were related ( P < 0.0001). However, MEPS-predicted ranges within subjective-health categories were large. Subjective health was a less reliable predictor of expenses among older adults (age × subjective health, P = 0.04). Neither significantly related to subsequent self-reported health care utilization ( P = 0.18, P = 0.92, respectively). Conclusions. Because MEPS data are nationally representative, they may approximate utilization better than subjective health, particularly among older adults. However, approximating health care utilization is difficult, especially among newly insured. Findings have implications for health insurance decision support tools that personalize plan displays based on cost estimates.

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