Development and status of health insurance systems in China

Barber, Sarah; Yao, Lan

doi:10.1002/hpm.1109

Cited by 82 publications

(88 citation statements)

References 7 publications

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“…Meanwhile, the access to health care in China was remarkably improved in the past decade. Insurance coverage increased from 7% in 1999 to 96% in 2011, 25,26 which greatly contributed to the improvements in awareness and treatment of hypertension. Nevertheless, a huge gap exists in dealing with hypertension between China and Western countries.…”

Section: Discussionmentioning

confidence: 99%

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in Shandong Province of China

Zhao

Lu²,

Sun³

et al. 2012

J of Clinical Hypertension

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J Clin Hypertens (Greenwich). 2012; 14:637–643. © 2012 Wiley Periodicals, Inc. The authors retrospectively examined data from 3 surveys on hypertension according to the 2010 Chinese Guidelines for the Management of Hypertension. These surveys were conducted in 1991, 1999, and 2007, and included 85,371 individuals 18 years and older who were living in Shandong Province, China. Age‐standardized prevalent hypertension increased from 15.6% in 1991 to 17.3% in 1999 and 32.7% in 2007 (both P<.0001). The ascending prevalence can be partially explained by increasing body weight. Among individuals with hypertension, awareness increased significantly from 27.8% in 1991 to 39.1% in 1999 and 49.2% in 2007. The proportion of pharmacologic treatment also considerably improved, with the estimate of 12.9%, 28.1%, and 43.3% in the 3 surveys, respectively. Hypertension control increased from 3.0% to 4.4% to 7.1% in the past 20 years. The upward trend in blood pressure control was mostly attributable to a rise among men and persons at middle age. This study suggests that the prevalence of hypertension increased in the Shandong population from 1991 to 2007. Although substantially improved, control rates were still unacceptably low. Comprehensive strategies are urgently required to put into practice for the management of hypertension in Shandong Province, China.

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Section: Discussionmentioning

confidence: 99%

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in Shandong Province of China

Zhao

Lu²,

Sun³

et al. 2012

J of Clinical Hypertension

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“…[28,29] This is in part attributable to various flawed arrangements within the insurance system, such as inappropriately set reimbursement ceilings and copayment rates, as well as the limited capacity of social insurance administration. [30,31] Among others things, the recalibration of reimbursement standards, especially for common diseases, is of critical importance in local insurance payment reforms.…”

Section: Discussionmentioning

confidence: 99%

Developing case-mix standards with the Diagnosis-related Groups for payment reforms and hospital management in China: A case study in Xiamen city

Zeng

Lin

et al. 2016

IJH

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Objective: To inform health insurance payment reforms and hospital cost management by investigating the case-mix of viral hepatitis, a common disease, in a Chinese city. Methods: All inpatient medical records of viral hepatitis of selected hospitals in Xiamen from 2008 to 2013 were collected. Both univariate and multivariate analyses were performed to test the association between hospitalization costs and other key variables. The CHAID model was employed to generate the Diagnosis-related Groups (DRGS). Evaluation indexes were adopted to evaluate the grouped results. Standard expenditures were estimated for each group. Results: Gender, age, marital status, mode of payment, admission condition, discharged condition and length of stay were found significantly associated with inpatient expenditures, with p values smaller than .001. Eleven diagnosis-related groups were obtained with the CHAID methods and three classification nodes were obtained from the CHAID decision tree, including age, admission status and mode of payment. The analysis revealed a considerable discrepancy in expenditures across groups with similar characteristics. This variance suggests the existence of inflated inpatient costs as well as inefficient use of medical resources. Conclusions: The analysis provided more accurate estimation on case-mix costs for a major disease in China. The standard expenditures are of reference values for the social insurance administration in calibrating reimbursement rates in its move to case-mix payment system and helpful for hospital cost management.

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“…While the major SHI schemes have covered the vast majority of citizens, the effect of financial protection remains shallow, in part due to limited benefits and rapid inflation of costs [3]. High deductibles and copayments, low reimbursement rates, and unsupportive claim procedures have introduced major barriers [4]. Moreover, China's decentralized and incremental approach to universal coverage has created a fragmented SHI system under which a series of structural deficiencies have caused not only additional barriers to access, but also had detrimental impacts on efficiency and public satisfaction.…”

Section: Introductionmentioning

confidence: 99%

Towards Universal Health Coverage via Social Health Insurance in China: Systemic Fragmentation, Reform Imperatives, and Policy Alternatives

Wu²

2016

Appl Health Econ Health Policy

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China's remarkable progress in building a comprehensive social health insurance (SHI) system was swift and impressive. Yet the country's decentralized and incremental approach towards universal coverage has created a fragmented SHI system under which a series of structural deficiencies have emerged with negative impacts. First, contingent on local conditions and financing capacity, benefit packages vary considerably across schemes, leading to systematic inequity. Second, the existence of multiple schemes, complicated by massive migration, has resulted in weak portability of SHI, creating further barriers to access. Third, many individuals are enrolled on multiple schemes, which causes inefficient use of government subsidies. Moral hazard and adverse selection are not effectively managed. The Chinese government announced its blueprint for integrating the urban and rural resident schemes in early 2016, paving the way for the ultimate consolidation of all SHI schemes and equal benefits for all. This article proposes three policy alternatives to inform the consolidation: (1) a single-pool system at the prefectural level with significant government subsidies, (2) a dual-pool system at the prefectural level with risk-equalization mechanisms, and (3) a household approach without merging existing pools. Vertical integration to the provincial level is unlikely to happen in the near future. Two caveats are raised to inform this transition towards universal health coverage.

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Development and status of health insurance systems in China

Cited by 82 publications

References 7 publications

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in Shandong Province of China

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in Shandong Province of China

Developing case-mix standards with the Diagnosis-related Groups for payment reforms and hospital management in China: A case study in Xiamen city

Towards Universal Health Coverage via Social Health Insurance in China: Systemic Fragmentation, Reform Imperatives, and Policy Alternatives

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