Advancing universal health coverage in China and Vietnam: lessons for other countries

Mao, Wenhui; Tang, Yuchen; Tran, Tra; Pender, Michelle; Khanh, Phuong Nguyen; Tang, Shenglan

doi:10.1186/s12889-020-09925-6

Cited by 22 publications

(31 citation statements)

References 17 publications

(16 reference statements)

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“…The results show that UEBMI, URBMI, and NRCMS had higher healthcare utilisation and experienced faster increases than uninsured respondents between 2008 and 2018. This implies that the rapid expansion of UEBMI, URBMI, and NRCMS with more generous benefits improved healthcare utilisation [ 2 , 19 , 26 , 27 ]. This finding closely parallels existing empirical studies on URBMI and NRCMS [ 7 , 28 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Empirical evidence has shown that the catastrophic health expenditure rate of those covered by NRCMS has increased significantly more than people covered by UEBMI and URBMI from 2000 to 2020 [ 39 ]. There are disparities in catastrophic health expenditure and impoverishment due to health expenditure among population income levels, and low-income households still have a higher chance of suffering financial hardship than high-income households [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

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Trends in disparities in healthcare utilisation between and within health insurances in China between 2008 and 2018: a repeated cross-sectional study

Yan

Liu

Cai

et al. 2022

Int J Equity Health

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Background Fragmentation in China’s social health insurance schemes and income gap have been recognised as important factors for the inequitable use of healthcare. This study assessed trends in disparities in healthcare utilisation between and within health insurances in China between 2008 and 2018. Methods We used data from the 2008, 2013, and 2018 China National Health Services Survey. Outpatient visit, inpatient admission and foregone inpatient care were chosen to measure healthcare utilisation and underutilisation by health insurances. Absolute differences and rate ratios were generated to examine disparities between and within health insurances, and changes in disparities were analysed descriptively. Pearson χ2 tests were used to test for statistical significance of differences. Results The outpatient visit rate for respondents covered by the urban resident-based basic medical insurance scheme (URBMI) more than doubled between 2008 and 2018, increasing from 10.5% (9.7-11.2) to 23.5% (23.1-23.8). Inpatient admission rates for respondents covered by URBMI and the new rural cooperative medical scheme (NRCMS) more than doubled between 2008 and 2018, increasing by 7.2 (p < 0.0001) and 7.4 (p < 0.0001) percentage points, respectively. Gaps in outpatient visits and inpatient admissions narrowed across the urban employee-based basic medical insurance scheme (UEBMI), URBMI, and NRCMS through 2008 to 2018, and by 2018 the gaps were small. The rate ratios of foregone inpatient care between NRCMS and UEBMI fell from 0.9 (p > 0.1) in 2008 to 0.8 (p < 0.0001) in 2018. Faster increases in outpatient and inpatient utilisation and greater reductions in foregone inpatient care were observed in poor groups than in wealthy groups within URBMI and NRCMS. However, the poor groups within UEBMI, URBMI, and NRCMS were always more likely to forego inpatient care in comparison with their wealthy counterparts. Conclusions Remarkable increases in healthcare utilisation of URBMI and NRCMS, especially among the poorest groups, were accompanied by improvements in inequality in healthcare utilisation across UEBMI, URBMI, and NRCMS, and in income-based inequality in healthcare utilisation within URBMI and NRCMS. However, the poor groups were always more likely to forego admission to hospital, as recommended by doctors. We suggest further focus on the foregoing admission care of the poor groups.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in disparities in healthcare utilisation between and within health insurances in China between 2008 and 2018: a repeated cross-sectional study

Yan

Liu

Cai

et al. 2022

Int J Equity Health

View full text Add to dashboard Cite

show abstract

“…The reasons for this status quo are complex. In China, the benefit is determined by the level of funding in different health insurances, and the UEBMI, the scheme with the highest financial support, has relatively better service benefits and financial protection [46]. As mentioned earlier, the service benefits package of the URBMI and NRCMS initially focused on inpatient services.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the incomes of Chinese urban and rural residents are very different. The government needs to consider how to set an acceptable premium rate during the transition period to facilitate participants participating in the insurance according to their economic status, and to subsidize vulnerable groups so that everyone can enjoy the right to health [46]. Finally, improving the poor interconnection caused by the separation of health insurance management agencies is necessary.…”

Section: Discussionmentioning

confidence: 99%

Benefits Associated with China’s Social Health Insurance Schemes: Trend Analysis and Associated Factors Since Health Reform

Dong

Zwi

Bai

et al. 2021

IJERPH

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With the deepening of health insurance reform in China, the integration of social health insurance schemes was put on the agenda. This paper aims to illustrate the achievements and the gaps in integration by demonstrating the trends in benefits available from the three social health insurance schemes, as well as the influencing factors. Data were drawn from the three waves of the China Health and Nutrition Survey (2009, 2011, 2015) undertaken since health reforms commenced. χ2, Kruskal–Wallis test, and the Two-Part model were employed in the analysis. The overall reimbursement rate of the Urban Employee Basic Medical Insurance (UEBMI) is higher than that of Urban Resident Basic Medical Insurance (URBMI) or the New Rural Cooperative Medical Scheme (NRCMS) (p < 0.001), but the gap has narrowed since health reform began in 2009. Both the outpatient and inpatient reimbursement amounts have increased through the URBMI and NRCMS. Illness severity, higher institutional level, and inpatient service were associated with significant increases in the amount of reimbursement received across the three survey waves. The health reform improved benefits covered by the URBMI and NRCMS, but gaps with the UEBMI still exist. The government should consider more the release of health benefits and how to lead toward healthcare equity.

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“…Others have found that China’s policy interventions strongly promote the development of internet hospitals in China. Political commitment, sustainable financial sources, and administrative capacity are strong driving factors for achieving universal health coverage (UHC) through health insurance reform [ 26 ].…”

Section: Literature Viewmentioning

confidence: 99%

Effects of Healthcare Policies and Reforms at the Primary Level in China: From the Evidence of Shenzhen Primary Care Reforms from 2018 to 2019

Wen

Liao

Yi-lin

et al. 2022

IJERPH

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Countries worldwide are making efforts to achieve health equity. China focuses on the implementation of the policy goal of “improving the primary level” to eliminate the health equity gap. The main purpose of this study is to examine the effects of the healthcare reforms at the primary level in China and to analyze the key factors that can help to improve their effectiveness. From the perspectives of the policy attention mechanism and public policy analysis, this study will explore primary care reforms from policy formulation to policy implementation on the basis of grounded theory and empirical research on primary care reforms in Shenzhen, China, that was conducted from 2018 to 2019. The present study found that the government pays close attention to the medical level and service level of primary care services at the policy formulation phase but less attention to talent level and information sharing. At the same time, this study combined with empirical data from primary care centers in Shenzhen for the period covering 2018 to 2019 evaluates policy implementation and its effect. Multiple regression analysis revealed that the medical level, talent level, service level, and information sharing helped to develop primary care services and improved health equity. Nevertheless, this study reflects a deviation between policy formulation and policy implementation for the development of primary care policies. Empirical experience shows that the development of talent level and information sharing can significantly promote primary care services and health management. Therefore, this study implies that in the process of promoting the health equity at the primary level, more attention should be paid to the consistency between policy formulation and policy implementation. Additionally, the policy promotion and influence mechanism can be improved, particularly in terms of talent development and information sharing, in order to effectively promote the development of health equity at the primary level.

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Advancing universal health coverage in China and Vietnam: lessons for other countries

Cited by 22 publications

References 17 publications

Trends in disparities in healthcare utilisation between and within health insurances in China between 2008 and 2018: a repeated cross-sectional study

Trends in disparities in healthcare utilisation between and within health insurances in China between 2008 and 2018: a repeated cross-sectional study

Benefits Associated with China’s Social Health Insurance Schemes: Trend Analysis and Associated Factors Since Health Reform

Effects of Healthcare Policies and Reforms at the Primary Level in China: From the Evidence of Shenzhen Primary Care Reforms from 2018 to 2019

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