Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

Liu, Xiaoyun; Tang, Shenglan; Yu, Bo; Phuong, Nguyen Thanh; Yan, Fei; Thien, Duong Duc; Tolhurst, Rachel

doi:10.1186/1475-9276-11-10

Cited by 69 publications

(59 citation statements)

References 24 publications

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“…64,65 Additionally, the implications of health insurance for health outcomes depend on their integration with other policies. For example, WHO SAGE data 35 show that a scarcity of health awareness in older people and of available health services (particularly in rural areas), and low treatment effectiveness, meant that insurance coverage was not associated with higher rates of hypertension control.…”

Section: Introductionmentioning

confidence: 99%

Macroeconomic implications of population ageing and selected policy responses

et al. 2015

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Between now and 2030, every country will experience population ageing—a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population—a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries’ economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasised disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties.

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Section: Introductionmentioning

confidence: 99%

Macroeconomic implications of population ageing and selected policy responses

et al. 2015

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“…This has continued into the current decade (33). This growth has been principally driven by increasing insurance coverage (34). The Chinese government has introduced three different types of health insurance in recent years each targeting different populations, with basic coverage reaching over 90% of the population in 2011 (33,(35)(36)(37) and 95% in 2013 (33).…”

Section: Introductionmentioning

confidence: 99%

Ongoing initiatives to improve prescribing efficiency in China; statins as a case history

Zhang

Godman

et al. 2014

GaBI J

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Introduction: Pharmaceutical expenditure rose by 16% per annum in China during the past decade, and now represents 46% of total health care expenditure. Initiatives to moderate growth include pricing regulations for pharmaceuticals and encouraging INN prescribing. However, there is limited monitoring of physician prescribing and current incentives encourage hospitals and physicians to profit from drug procurement. Objective: Assess changes in statin utilisation and expenditure as additional generics are launched. Subsequently, compare results in China with findings among European countries to provide future guidance. Methods: Observational retrospective study of statin utilisation and procurement expenditure from 2004 to 2013 in two large teaching hospital groups. Results: Statin utilisation rose 32 fold in one hospital group and 54 fold in the other. Expenditure also increased but to a lesser extent, i.e. from just over CNY 0.65 million in 2004 to 15.3 million in 2013 in one hospital group and from CNY 0.49 to 19.3 million in the other. Atorvastatin (originator) was the most utilised statin. Utilisation of each generic statin was typically low, e.g. 10% in 2013 in one hospital group. Procurement prices fell over time, greatest for generic simvastatin (-74 to -91%) mirroring data from European countries. However, no increase in their prescribing was observed. In fact, a significant decrease in generic prescribing was seen in one hospital group between 2004 and 2013. Conclusion: There are considerable opportunities to improve prescribing efficiency in China based on European experience. However, current incentives encouraging hospitals and physicians to profit from drug procurement need to be addressed.

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“…Thus, patients prefer to purchase the same OTC medicines since it would be less expensive than using prescribed medicines. Additionally, patients in China have poor accessibility to formal medical care due to a shortage of healthcare providers, low level of insurance coverage for patients with chronic diseases, especially in rural areas [35,36], which is different from cases in developed countries [21][22][23]. Similar phenomenon were also found in another study low income rural population without health insurance only sought medical care when illness was at a severe or acute stage [37].…”

Section: Discussionmentioning

confidence: 72%

The Relationship between Self-Treatment and Outpatient Visits: Findings from a National Survey in China

Luo¹

2017

J Geriatr Med Gerontol

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Emerging large number of patients with chronic diseases, present special challenges for modern health system. Self-treatment may be an alternative approach to meet the healthcare demand, and currently of great interest in many countries. However, whether self-treatment can decrease the use of formal health care, especially outpatient visits, is still not clear. No empirical study has been conducted to examine the relationship between self-treatment and outpatient visits of individuals with chronic diseases under China's unique bifurcated healthcare system. The baseline data of a national survey of Chinese Health and Retirement Longitudinal Study (CHARLS) conducted in 2011-2012 among respondents aged 45+ was used in this study. Survey logistic regression models were applied to explore the association between self-treatment and outpatient visits under the framework of the Anderson Behavior Model among 11,673 respondents. Results showed that Over-thecounter (OTC) medicines consumption was the main mode of self-treatment in China. Respondents with OTC medicines consumption had fewer outpatient visits in the previous month than their counterparts (30.1% vs. 41.0%, p < 0.01). After controlling socio-demographic factors, lifestyles, number of chronic diseases, self-reported health status, depressive symptoms and health insurance, the negative association between OTC medicines consumption and outpatient visit remained significant (OR = 0.45, 95% CI: 0.39, 0.53). These findings suggest that self-treatment, especially OTC medicines consumption, may decrease outpatient visits for adults with chronic diseases in China.

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Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

Cited by 69 publications

References 24 publications

Macroeconomic implications of population ageing and selected policy responses

Macroeconomic implications of population ageing and selected policy responses

Ongoing initiatives to improve prescribing efficiency in China; statins as a case history

The Relationship between Self-Treatment and Outpatient Visits: Findings from a National Survey in China

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