Enhancing financial protection under China’s social health insurance to achieve universal health coverage

Fang, Hai; Eggleston, Karen; Hanson, Kara; Wu, Ming

doi:10.1136/bmj.l2378

Cited by 120 publications

(139 citation statements)

References 12 publications

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“…In 2009, China launched a new comprehensive health system reform, which focused on five areas: service delivery, essential medicines, public health service, social health insurance, and public hospital reform. The Chinese government has implemented a series of measures to ensure the provision of accessible and affordable care to cancer patients and protect their health and wellbeing since the 2009 health system reform [2,3]. Almost the entire Chinese population (more than 95% of total) has been covered by one of three social health insurance programs, including the Urban Employee Basic Medical Insurance (UEBMI) Scheme, the Urban Resident Basic Medical Insurance (URBMI) Scheme, and the New Rural Cooperative Medical Scheme.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

Zhao

Zhang

et al. 2020

IJERPH

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Background: This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE. Methods: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE. Results: The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas. Conclusion: Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.

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Section: Introductionmentioning

confidence: 99%

Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

Zhao

Zhang

et al. 2020

IJERPH

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“…A report by the World Bank and the World Health Organization indicated that China secured a high score for essential health service coverage but a low score for financial protection. 34,35 In October 2016, 36 resident basic medical insurance (URBMI), and the rural new cooperative medical scheme (RNCMS), along with private insurance. 37 These insurance schemes covered approximately 95% of the Chinese population, which represents near-universal health insurance coverage in 2011.…”

Section: China's Health Financing Reformmentioning

confidence: 99%

“…Hospital authorities focus on more diagnostic tests to compensate for the loss of income generated from drug markup, 49 resulting in increased OOP payments. 35 A fragmented information system prevents value-based procurement, and the lack of an efficient evaluation and monitoring system weakens evidence-based data preservation. 50 In addition, hospital managers lack the autonomy to accomplish internal transformation (eg, hiring/firing and salary issues).…”

Section: Challenges Remaining In Out-of-pocket Paymentsmentioning

confidence: 99%

Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries

Zhang

Rahman

2020

Health Planning & Management

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This study aims to assess the association between Chinese out‐of‐pocket payments and government health spending, investigating their variation ratio in the context of OECD countries. Aggregated time‐series data of 37 countries (from China and official OECD members) were collected from the World Bank Open Data source and analyzed using the multiple linear regression models. Benchmarking approach was applied to evaluate the causes of healthcare expenditure rise per capita. The results showed that China's government health expenditure was positively associated with out‐of‐pocket payment rise, with a higher variation score of 42.70%. The association was statistically significant at 5%. Likewise, the association between government expenditure and out‐of‐pocket payment in the OECD countries was positively significant at 1%, and their variation score was 2.41%. Health financing in OECD countries showed higher stability and equity than that in China. Policy implications for China is to reduce the distributional disparity of government health funds by tax adjustments in health services, universal health coverage, the removal of social health insurance disparities, and a single health payment method.

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“…In China, there were two health insurance schemes designed exclusively for urban residents: Urban Employee Basic Medical Insurance scheme (UEBMI) for the urban employed and theUrban Resident Basic Medical Insurance scheme (URBMI) for the urban unemployed, retired, children and students,who were not covered by the UEBMI [11]. Covering more than 95% of the residents in urban China during the 2013-2016 period, the two schemes covered roughly 750 million, or 54%, of the total Chinese population [12].The basic differences between UEBMI and URBMI are set out in Table 1.UEBMI is funded both by employers (2% of wages) and employees (6% of annual wages) [13], while the revenue for the URBMI is from individual premium contributions and subsides from central and local government.As shown in Table 1, UEBMIprovides better nancial protection and offers a more comprehensive coverage than URBMI, which focuses on inpatient services, catastrophic illness insurance, but withlimited coverage of basic outpatient services [14]. Patients with UEBMI usually utilize more health services and have higher expense than those with URBMI [15].…”

Section: Introductionmentioning

confidence: 99%

Geographic Variations in Stroke Inpatient Healthcare Utilization and Hospital Expenditure Equity in China

Yang

Nicholas²,

Maitland

et al. 2020

Preprint

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Background: Stroke is a devastating disease that imposes a heavy financial burden on patients and their families and a significant economic cost on a nation’s healthcare system. Under China’s fragmented health insurance system, it was unclear whether geographic variations in healthcare utilization and hospital expenditures lead to healthcare inequities for stroke inpatients. This study assesses the geographic variations in stroke patients’ healthcare utilization and hospital expenses and the potential geographical influencing factors. Methods: Covering all municipalities and provinces in mainland China, our main data were a 5% random sample of stroke claims from the Urban Employees Basic Medical Insurance (UEBMI) and Urban Residents Basic Medical Insurance (URBMI) schemes from 2013 to 2016, totaling 217969 inpatients and 280804 admissions. The Theil index was employed to evaluate the (in)equity in healthcare utilization and hospital expenditures across all 31 mainland Chinese provinces. Using multiple linear regression analysis, the geographic influencing factors, comprising ability to deliver healthcare, geographical accessibility of health services, healthcare-seeking and economic factors, were explored.Results: UEBMI stroke inpatients had higher hospital costs and longer ALOS, but lower OOP expenses than those with URBMI. UEBMI insurance had a lower Theil index value than the URBMI scheme. Stroke patients’ healthcare utilization and hospital expenditures showed significant differences both within and between regions. The intra-region Theil (in)equality index value was higher than the inter-region Theil index, with the Theil index highest within eastern China, China’s richest and most developed region. The ability to deliver healthcare, the enabling factors and the provincial-level economic factors had significant effects (P<0.05) on healthcare utilization and hospital expenses.Conclusions: Our data revealed significant geographic variation in healthcare utilization and hospital expenditures for stroke patients. In addition to differences in the coverage and reimbursements of the UEBMI-URBMI schemes, disparities within regions were associated with the ability to deliver healthcare (open hospital beds per 100 patients), the enabling factors (regional reimbursement rate and regional education level) and the provincial-level economic factors (GDP per capita). China’s fragmented urban health insurance schemes require further reform to ensure better equity in healthcare utilization and hospital expenses.

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Enhancing financial protection under China’s social health insurance to achieve universal health coverage

Abstract: Hai Fang and colleagues highlight the need for better financial protection for poor people

Cited by 120 publications

References 12 publications

Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries

Geographic Variations in Stroke Inpatient Healthcare Utilization and Hospital Expenditure Equity in China

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