Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study

Meng, Qun; Xu, Lei; Zhang, Yaoguang; Qian, Juncheng; Cai, Min; Xin, Ying; Gao, Jun; Xu, Kun; Boerma, J. Ties; Barber, Sarah

doi:10.1016/s0140-6736(12)60278-5

Cited by 570 publications

(617 citation statements)

References 9 publications

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“…2 In China, health insurance coverage has increased dramatically over the last decade, from 15% in 2000 to 96% in 2011. 3,4 The Medical Insurance for Urban Employees (MIUE) scheme, designed exclusively for urban employees, is a mandatory programme based on cost sharing between employers and employees, with risk pooling managed at the municipal level. 5 The Medical Insurance for Urban Residents scheme (MIUR) is for urban residents who are not covered by the MIUE and is co-financed by enrolees and local government.…”

Section: Introductionmentioning

confidence: 99%

“…6 The New Cooperative Medical Scheme (NCMS) is a voluntary programme based on cost sharing between government and farmers and covers mostly inpatient services and a few outpatient services. 7 However, despite China's great strides in health insurance coverage, 4,8 in a more comprehensive sense such coverage is not universal. It falls short when held up to the definition of universal coverage put forth by the World Health Organization (WHO), which includes equitable access to health services for all at an affordable cost and has three dimensions: breadth, depth and height.…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance

Xu³

et al. 2012

Bull World Health Org

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408

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance

Xu³

et al. 2012

Bull World Health Org

Self Cite

366

408

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“…Indicators of socio-economic vulnerability converged geographically to form geographical clusters of inequity, reflecting the multi-dimensional and intersectional nature of deprivation [2,3,25]. …”

Section: Discussionmentioning

confidence: 99%

Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index

Nandi

Schneider

Garg

2018

Global Health Action

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Background: Countries are increasingly adopting health insurance schemes for achieving Universal Health Coverage. India’s state-funded health insurance scheme covers hospital care provided by ‘empanelled’ private and public hospitals. Objective: This paper assesses geographical equity in availability of hospital services under the universal health insurance scheme in Chhattisgarh state. Methods: The study makes use of district data from the insurance scheme and government surveys. Selected socio-economic indicators are combined to form a composite vulnerability index, which is used to rank and group the state’s 27 districts into tertiles, named as highest, middle and lowest vulnerability districts (HVDs, MVDs, LVDs). Indicators of hospital service availability under the scheme – insurance coverage, number of empanelled private/public hospitals, numbers and amounts of claims – are compared across districts and tertiles. Two measures of inequality, difference and ratio, are used to compare availability between tertiles. Results: The study finds that there is a geographical pattern to vulnerability in Chhattisgarh state. Vulnerability increases with distance from the state’s centre towards the periphery. The highest vulnerability districts have the highest insurance coverage, but the lowest availability of empanelled hospitals (3.4 hospitals per 100,000 enrolled in HVDs, vs 8.2/100,000 enrolled in LVDs). While public sector hospitals are distributed equally, the distribution of private hospitals across tertiles is highly unequal, with higher availability in LVDs. The number of claims (per 100,000 enrolled) in the HVDs is 3.5-times less than that in the LVDs. The claim amounts show a similar pattern. Conclusions: Although insurance coverage is higher in the more vulnerable districts, availability of hospital services is inversely proportional to vulnerability and, therefore, the need for these services. Equitable enrolment in health insurance schemes does not automatically translate into equitable access to healthcare, which is also dependent on availability and specific dynamics of service provision under the scheme.

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“…First, though the wellintended goal of China's health care reform is to reduce the heavy financial burden on citizens, social health insurance covering close to 100% of the population has yet to have a significant impact, especially in mitigating the out-of-pocket burden caused by catastrophic diseases. [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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Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study

Cited by 570 publications

References 9 publications

Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance

Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance

Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index

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

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