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

ObjectiveThe implementation of the outpatient pooling scheme in China has substantially elevated the compensation levels for outpatient expenses. This study aims to assess whether socioeconomically disadvantaged enrollees benefit proportionally compared to their non-disadvantaged counterparts.MethodA cohort comprising 14,581 Urban and Rural Resident Basic Medical Insurance (URRBMI) enrollees and 830 Urban Employee Basic Medical Insurance (UEBMI) enrollees was derived from the China Health and Retirement Longitudinal Study 2018. Outpatient pooling scheme benefits were evaluated based on two metrics: the probability of obtaining benefits and the magnitude of benefits (reimbursement amounts and ratios). Two-part models were employed to adjust outpatient benefits for healthcare needs. Inequality in benefit distribution was assessed using the concentration curve and concentration index (CI).ResultsFollowing adjustments for healthcare needs, the CI for the probability of receiving outpatient benefits for URRBMI and UEBMI enrollees were − 0.0760 and − 0.0514, respectively, indicating an evident pro-poor pattern under the outpatient pooling scheme. However, the CIs of reimbursement amounts (0.0708) and ratio (0.0761) for URRBMI recipients were positive, signifying a discernible pro-rich inequality in the degree of benefits. Conversely, socioeconomically disadvantaged UEBMI enrollees received higher reimbursement amounts and ratios.ConclusionDespite a higher likelihood of socioeconomically disadvantaged groups receiving outpatient benefits, a pro-rich inequality persists in the degree of benefits under the outpatient pooling scheme in China. Comprehensive strategies, including expanding outpatient financial benefits, adopting distinct reimbursement standards, and enhancing the accessibility of outpatient care, need to be implemented to achieve equity in benefits distribution.

Section: Discussionmentioning

confidence: 99%

“…Firstly, the ongoing reform of merging NCMS and URBMI into URRBMI was conducting from 2012 to 2016. Previous studies proved integrated URRBMI improves healthcare and benefit equity (8,22). To eliminate the confounding effects of this policy, the data collected after 2016 is appropriate.…”

Section: Data Sourcesmentioning

confidence: 99%

Inequality in benefit distribution of reducing the outpatient cost-sharing: evidence from the outpatient pooling scheme in China

Zhang,

Chen

2024

“…Following the approach used by relevant scholars, this study selects the “participation rate of urban-rural resident health insurance in other prefecture-level cities within the same province” as the instrumental variable ( 27 – 30 ). In terms of relevance, after the State Council released the “Opinions on Integrating the Basic health insurance Systems for Urban and Rural Residents” in 2016, various provinces successively issued their own policies for integrating the basic health insurance system for urban and rural residents, outlining integration schedules ( 31 , 32 ). Provinces supervise and encourage cities at the prefecture-level to promote the integration of urban and rural resident health insurance.…”

Section: Baseline Regression Analysis Of the Impact Of Urban-rural Re...mentioning

confidence: 99%

Does the increase in health insurance benefits have different effects on the health of middle-aged and older people individuals in rural areas? Analysis based on quantile difference-in-differences method

Qin,

Wang

2024

In the context of healthy aging, enhancing health performance is an intrinsic requirement for the development and reform of the health insurance system. This paper mainly discusses the health effects of increasing medical insurance benefits on people with different levels of health. So this paper utilizes multiple rounds of data from the China Health and Retirement Longitudinal Study (CHARLS) and employs the quantile difference-in-differences method to systematically investigate the impact effects of the integration of urban and rural residents' health insurance on the frailty levels of rural middle-aged and older people individuals. The research findings are as follows: Firstly, the integration of urban and rural resident health insurance has mitigated the frailty level of rural older people individuals, with a more pronounced impact on those with poorer health statuses. Secondly, in terms of heterogeneity analysis, the health performance effects of the urban-rural health insurance integration policy are more significant among the older people population and in the western regions. Thirdly, the integration of urban and rural resident health insurance primarily improves health by reducing the burden of medical expenses, with a greater impact on the older people population with poorer health statuses. Based on the research findings, we recommend addressing the disparities in healthcare benefits across various insurance systems, alleviating the financial burden of healthcare for impoverished individuals, and consistently improving the coordination of healthcare insurance policies for both urban and rural residents.

“…The basic medical insurance system for urban and rural residents mainly caters to the healthcare needs of rural residents, urban residents, students and children. In contrast, the basic medical insurance for urban workers is specifically designed to meet the healthcare needs of urban workers ( 12 , 13 ). In terms of system design, the two types of health insurance show fundamental differences due to different resource endowments, with the actual reimbursement rate and affordability of urban and rural residents lower than those of urban workers ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

The influence of the national drug price negotiation policy reform on the medical expenses of patients in Xuzhou City: an interrupted time series analysis

Qin,

He,

Shen

et al. 2024

BackgroundTo reduce the burden of patients’ medical care, the Xuzhou Municipal Government has initiated an exploratory study on the supply model and categorized management of nationally negotiated drugs. This study aims to understand the extent to which Xuzhou’s 2021 reform of the National Drug Price Negotiation (NDPN) policy has had a positive impact on the healthcare costs of individuals with different types of health insurance.MethodsThe Interrupted Time Series Analysis method was adopted, and the changes in average medical expenses per patient, average medical insurance payment cost per patient and actual reimbursement ratio were investigated by using the data of single-drug payments in Xuzhou from October 2020 to October 2022.ResultsFollowing the implementation of the policy, there was a significant decrease in the average medical expenses per patient of national drug negotiation in Xuzhou, with a reduction of 62.42 yuan per month (p < 0.001). Additionally, the average medical insurance payment cost per patient decreased by 44.13 yuan per month (p = 0.01). Furthermore, the average medical expenses per patient of urban and rural medical insurance participants decreased by 63.45 yuan (p < 0.001), and the average monthly medical insurance payment cost per patient decreased by 57.56 yuan (p < 0.04). However, the mean total medical expenditures for individuals enrolled in employee medical insurance decreased by 63.41 yuan per month (p < 0.001), whereas the monthly decrease was 22.11 yuan per month (p = 0.21). On the other hand, there was no discernible change in the actual reimbursement ratio.ConclusionAfter the adoption of the NDPN policy, a noticeable decline has been observed in the average medical expenses per patient and the mean cost of the average medical insurance payment per patient, although to a limited extent. Notably, the reduction in employee medical insurance surpasses that of urban and rural medical insurance.