Did the Integrated Urban and Rural Resident Basic Medical Insurance Improve Benefit Equity in China?

Ren, Yangling; Zhou, Zhongliang; Cao, Dan; Hua, Bernice; Shen, Chi; Lai, Sha; Chen, Gang

doi:10.1016/j.jval.2022.03.007

Cited by 32 publications

(33 citation statements)

References 32 publications

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“…The basic insurance system offered by the Chinese government consists of three schemes: UEBMI, which provides health insurance to formal-sector urban employees and retirees; URBMI, which aims to insure the urban residents not covered by the UEBMI, such as students and the self-employed; and NCMS, which is a voluntary medical insurance scheme targeting rural residents ( 44 ). In 2016, the State Council announced that it would integrate the NCMS and URBMI into URBMI (Urban and Rural Resident Basic Medical Insurance) to integrate fragmented medical insurance schemes and reduce inequity ( 63 ). We found that all schemes were significantly associated with a higher probability of medical service utilization, whether outpatient or inpatient.…”

Section: Discussionmentioning

confidence: 99%

Does self-medication reduce medical expenditure among the middle-aged and elderly population? A four-wave longitudinal study in China

Zheng

Feng

Zhang

et al. 2023

Front. Public Health

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IntroductionSelf-medication has a high prevalence in the middle-aged and elderly population in China. Despite the published evidence demonstrating the economic benefits of self-medication, limited research has addressed the relationship between self-medication and individual medical expenditures, especially within the Chinese population. This study examined the effect of self-medication on individual medical expenditures in China and analyzed the heterogeneity between outpatient and inpatient cases.MethodsWe conducted a panel data analysis using data from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Two-part mixed-effect models were implemented to estimate the effect of self-medication on total outpatient and inpatient expenses and out-of-pocket (OOP) costs, where mixed-effects logit regression was used as the first part, and generalized linear mixed models with log link and gamma distribution was used as the second part.ResultsWe identified 72,041 responses representing 24,641 individuals, of which 13,185 responses incurred outpatient expenses and 9,003 responses incurred inpatient costs. Controlling for all covariates, we found that self-medication behaviors were significantly associated with a higher probability of outpatient service utilization (OR = 1.250, 95% CI = 0.179 to 0.269; P < 0.001), but displayed no significant association with outpatient expenses. Respondents who had taken self-medication were less likely to use inpatient services (OR = 0.865, 95% CI = −0.201 to −0.089; P < 0.001), and their inpatient expenses were significantly reduced by 9.4% (P < 0.001). Inpatient OOP costs were significantly reduced by 10.7% (P < 0.001), and outpatient OOP costs were significantly increased by 11.3% (P < 0.001) among respondents who had self-medicated.ConclusionsThis study allowed us to identify the economic value of self-medication among the middle-aged and elderly population in China. Future work should guide the middle-aged and elderly to take responsible self-medication to reduce their economic burden.

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Section: Discussionmentioning

confidence: 99%

Does self-medication reduce medical expenditure among the middle-aged and elderly population? A four-wave longitudinal study in China

Zheng

Feng

Zhang

et al. 2023

Front. Public Health

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“…However, the above ndings are in uenced by various aspects such as policy design, research methodology, and data. For example, Ren (2022) found that residents' health improved signi cantly after switching from low-grade to high-grade health insurance based on the urban-rural health insurance coordination pilot in Taicang and Yixing cities. However, Ma (2021) found, based on nationwide survey data, that although the policy of integrating urban and rural residents' health insurance signi cantly improves residents' health, it promotes health inequality.…”

Section: I Literature Review (I) Impact Of Health Insurance Coordinat...mentioning

confidence: 99%

Can benefit equity alleviate health inequity? --Evidence from the reform of Health Insurance Programs in China

2022

Preprint

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The higher the socioeconomic status, the better the health status. Can the equity reform of health insurance alleviate the health inequality between different groups? Taking the provincial-level coordination reform of Chinese Urban Employee Basic Medical Insurance (UEBMI) as an example, the paper used the China Family Panel Studies (CFPS) data and relevant policy documents to examine the effect of equalized health insurance programs on health inequity by Recentered Influence Function (RIF). The empirical results showed that although the gap in medical reimbursement costs between participants of different socioeconomic status was narrowing after the provincial-level coordination reform, the health inequality among the insured population widened. The equalized health insurance reform can’t alleviate the health inequality brought about by socioeconomic status. This paper suggests that in the progress of promoting the provincial-level coordination reform of UEBMI, the protection of vulnerable groups should be strengthened to promote social equity.JEL codes: I10, I14, I30

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“…Li et al ( 21 ) revealed that the integration of URRBMI could improve equity in healthcare utilization. Ren et al ( 22 ) provided evidence of benefit equity for outpatient care with the integration of URRBMI.…”

Section: Introductionmentioning

confidence: 99%

Effects of Urban and Rural Resident Basic Medical Insurance on Healthcare Utilization Inequality in China

Zhang¹,

Chen²,

Fang³

2023

Int J Public Health

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Objectives: This study aims to evaluate the effects of Urban and Rural Resident Basic Medical Insurance (URRBMI) integration on healthcare utilization and explore the contribution of URRBMI to healthcare utilization inequality among middle-aged and older adults.Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2018. The difference-in-difference model, concentration index (CI), and decomposition method were adopted.Results: The results suggested that the probability of outpatient visits and the number of outpatient visits had decreased by 18.2% and 10.0% respectively, and the number of inpatient visits had increased by 3.6%. However, URRBMI had an insignificant effect on the probability of inpatient visits. A pro-poor inequality for the treatment group was observed. The decomposition revealed that the URRBMI contributed to the pro-poor inequality in healthcare utilization.Conclusion: The findings suggest that URRBMI integration has decreased outpatient care utilization and improved the number of inpatient visits. While the URRBMI has improved healthcare utilization inequality, some challenges still exist. Comprehensive measures should be taken in the future.

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Did the Integrated Urban and Rural Resident Basic Medical Insurance Improve Benefit Equity in China?

Cited by 32 publications

References 32 publications

Does self-medication reduce medical expenditure among the middle-aged and elderly population? A four-wave longitudinal study in China

Does self-medication reduce medical expenditure among the middle-aged and elderly population? A four-wave longitudinal study in China

Can benefit equity alleviate health inequity? --Evidence from the reform of Health Insurance Programs in China

Effects of Urban and Rural Resident Basic Medical Insurance on Healthcare Utilization Inequality in China

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