Background The New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind. Over time, several concerns about this program have been raised related to healthcare utilization disparities for NCMS participants in urban versus rural regions. Our study uses 2015 national survey data to evaluate the extent of these urban and rural disparities among NCMS beneficiaries. Methods Data for our study are based on the Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our 12,190-patient sample are urban and rural patients insured by NCMS. We use logistic regression analyses to compare the extent of disparities for urban and rural residence of NCMS beneficiaries in (1) whether individuals received any inpatient or outpatient care during 2015 and (2) for those individuals that did receive care, the extent of the variation in the number of inpatient and outpatient visits among each group. Results Our regression results reveal that for urban and rural NCMS patients in 2015, there were no significant differences in inpatient or outpatient utilization for either of the dependent variables – 1) whether or not the patient had a visit during the last year, or 2) for those that had a visit, the number of visits they had. Patient characteristics: age, sex, employment, health status, chronic conditions, and per capita annual expenditures – all had significant impacts on whether or not there was an inpatient or outpatient visit but less influence on the number of inpatient or outpatient visits. Conclusions For both access to inpatient and outpatient facilities and the level of utilization of these facilities, our results reveal that both urban and rural NCMS patients have similar levels of resource utilization. These results from 2015 indicate that utilization angst about urban and rural disparities in NCMS patients do not appear to be a significant concern.

Objective To measure the economic risk of diseases in Chinese middle-aged and elderly patients with diabetes. Methods The economic risk of diseases in Chinese middle-aged and elderly patients with diabetes was comprehensively analyzed using the family economic risk of diseases, catastrophic health expenditure, and relative risk of the disease. Results The proportions of families with low, medium, and high family economic risk of diseases were 64.73%, 8.56%, and 26.71%, respectively. When the defining criteria are 15%, 25%, and 40%, the incidences of catastrophic health expenditure were 66.71%, 60.07%, and 54.59%, respectively. The health expenditure of diabetic patients was 1.80 times that of non-diabetic patients when the difference in patients' income was eliminated. Conclusion In general, Chinese middle-aged and elderly patients with diabetes face a large economic risk of diseases, which will seriously hinder the improvement of their family life quality. The sociodemographic characteristics related to diabetics will aggravate the patient's economic risk, such as smoking, drinking, and low household income. Moreover, diabetes patients with different basic medical insurance have different economic risk of diseases. Keywords Middle-aged and elderly. Diabetes patients. Diseases' economic risk. China

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ObjectivesTo investigate whether regional variation changes with different beneficiary health insurance coverage types.DesignA cross-sectional study of the Health and Retirement Study (HRS) in 2018 was used.SettingMedicare beneficiaries only covered by Medicare (group 1) are compared with those covered by Medicare and other health insurance (group 2). Outcomes included healthcare usage measures: (1) whether beneficiaries have a hospital stay and (2) the number for those with at least one stay; (3) whether beneficiaries have a doctor’s visit and (4) the number for those with at least one visit. We compared healthcare usage in both groups across the five regions: (1) New England and Mid-Atlantic; (2) East North Central and West North Central; (3) South Atlantic; (4) East South Central and West South Central; (5) Mountain and Pacific. We used logistic regression for binary outcomes and negative binomial regression for count outcomes in each group.ParticipantsWe identified 8749 Medicare beneficiaries, of which 4098 in group 1 and 4651 in group 2.ResultsResidents in all non-reference regions had a significantly lower probability of seeking a doctor’s visit in group 1 (OR with 95% CI 0.606 (0.374 to 0.982), 0.619 (0.392 to 0.977), 0.472 (0.299 to 0.746) and 0.618 (0.386 to 0.990) in the order of above regions, respectively), which is not significant in group 2. Residents in most non-reference regions (except South Atlantic) had a significantly fewer number of seeking a hospital stay in group 2 (incident rate ratio (IRR) with 95% CI 0.797 (0.691 to 0.919), 0.740 (0.643 to 0.865), 0.726 (0.613 to 0.859) in the order of above regions, respectively), which is not significant in group 1.ConclusionRegional variation in the likelihood of having a doctor’s visit was reduced in Medicare beneficiaries covered by supplemental health insurance. Regional variation in hospital stays was accentuated among Medicare beneficiaries covered by supplemental health insurance.

Background The New Cooperative Medical Scheme (NCMS) is a social health insurance available to rural Chinese residents. Over time, several concerns to this system have been raised, including disparities among healthcare utilization and expenditures. Most studies only discuss disparities in general in NCMS, with few studies concentrating on comparing disparities between urban and rural regions. Moreover, this issue has an increasing importance due to the rapid population growth of rural migrants. Therefore, we conducted our study to explore urban and rural disparities among NCMS beneficiaries.Methods Our study is based on Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our targeted sample is individuals with rural hukou and only covered by NCMS. We define and use influential factors in our logistic regressions and descriptive tables to compare urban and rural disparities among these NCMS beneficiaries. Results In terms of inpatient care, urban beneficiaries have a lower probability (OR=1.013, P=0.892) and frequency (1.39 vs. 1.47, P=0.131) of having an inpatient visit than rural beneficiaries. However, urban beneficiaries have higher out-of-pocket (OOP) expenditures among inpatient visit (￥6788.98 vs. ￥6163.92, P=0.470) and medicine (￥3907.30 vs. ￥2649.67, P<0.01). In addition, urban beneficiaries were found to have higher reimbursement of inpatient visit (￥4457.66 vs. ￥4127.83, P<0.001) and medicine (￥2466.93 vs. ￥1774.55, P<0.05). In terms of outpatient care, urban beneficiaries have less possibility (OR=1.074, P=0.384) and frequency (2.15 vs. 2.26, P=0.225) of an outpatient visit than rural beneficiaries. Moreover, compared to rural beneficiaries, urban beneficiaries have less out-of-pocket (OOP) expenditures of outpatient visit (￥709.80 vs. ￥ 710.98, P=0.608) and drugs (￥448.68 vs. ￥ 522.95, P=0.645), and less reimbursement of outpatient visit (￥296.03 vs. ￥ 344.51, P=0.808) and drugs (￥99.25 vs. ￥ 114.60, P<0.05).Conclusion In terms of healthcare utilization, rural beneficiaries have both higher probability and frequency of inpatient and outpatient visits. In terms of healthcare expenditures, urban beneficiaries get more inpatient reimbursement with higher inpatient expenditures, while rural beneficiaries get more outpatient reimbursement with higher outpatient expenditures. Both situations have not solid answer yet, and therefore require further research.