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 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 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 A 15-Year Trend of Catastrophic Health Payment and its Inequality in China: Evidence from Longitudinal Data

2021 ◽  
Author(s):  
Yongjian Xu ◽  
Yiting Zhou ◽  
Andi Pramono
Keyword(s):  
Health Care ◽  
Decomposition Analysis ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Chinese Government ◽  
Nutrition Survey ◽  
Basic Medical Insurance ◽  
Poor Households ◽  
Health Payment ◽  
Basic Medical

Abstract Background：The Chinese health care system has gone through two major cycles of reform since the 1980s. This study aims to comprehensively track the trends in the occurrence of catastrophic health payment and its inequality in the past 15 years, which may help better understand the influence of health system reforms on catastrophic health payment and its inequality. Methods：The study employed the subset of data from China Health and Nutrition Survey conducted from 1991 to 2015. Concentration index and decomposition analysis were used to measure the magnitude of income-related inequality in catastrophic health payment and decompose it into determinants respectively. Results: The incidence of catastrophic health expenditure in China increased from 3.10% in 1993 to 8.90% in 2004, and still maintained at a high level in the following years. The incidence gap of catastrophic health payment between the richest and poorest became increasingly wider over year. Moreover, the adjusted concentration indexes were all negative in each year, decreasing from -0.202 in 1991 to -0.613 in 2015. The basic medical insurance didn’t decrease the incidence of catastrophic health payment and showed the second largest contribution on the inequality in catastrophic health payment before 2004. However, this contribution began to decline after 2006. Conclusions: After the New Health Care Reform, although the Chinese government has taken many measures to protect poor households from catastrophic health payment, the incidence gap between the rich and poor has widened. China has nearly achieved universal coverage in recent years, however, the basic medical insurance in China was not enough to protect households from catastrophic health payment. Our study suggests that improving the generosity of existing basic medical insurance, and reforming the medical insurance payment system would be helpful to reduce the incidence of catastrophic health payment. The use of big data tools and techniques to effectively screen the poor households, and strengthening the social medical aid system would be helpful to decrease the pro-rich inequality in catastrophic health payment.

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 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.

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

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.

scholarly journals Synergistic mechanism of basic medical insurance and public health policy under major public crisis

2020 ◽  
Author(s):  
Wei He ◽  
Huan liu ◽  
Tiantian Hu
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Policy ◽  
Public Health Policy ◽  
Health Benefits ◽  
Medical Insurance ◽  
Health Production ◽  
Coordinated Development ◽  
Basic Medical Insurance ◽  
Basic Medical

Abstract Background The coordinated development of the basic medical insurance system and public health is not only related to the structural soundness of the entire country’s medical and health system, but also related to a country’s initiative in responding to major public health events. Methods This article attempts to endogenously implement health care policies in the health production function, and from the perspective of health benefits, attempts to build a theoretical analysis of framework for the coordinated development of basic medical insurance and public health, revealing the benignly interactive circulation mechanism of the health care system and improving the health benefits of individuals and society realistic path. Results In the field of medical and health services, the establishment of a benign medical and health investment system can promote the improvement of the level of health output and the improvement of the health effectiveness of individuals and society, and thus promote the increase of social and individual health and welfare levels; and promote a virtuous cycle of overall healthy reproduction. Conclusions Under the synergy mechanism, the basic medical insurance policy and public health policy during the new coronary pneumonia should meet the synergy standards. Scientific and reasonable medical and health service policies should not only consider the treatment of new coronary pneumonia patients and group prevention and control, but also pay attention to the coordination of basic medical insurance policies and public health policies, and the coordination of health production and health benefits. The core of policy coordination is to protect both patients with new coronary pneumonia and the general medical and health services of residents.

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