Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China
Background: Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China's health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in i...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019
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| Online Access: | https://eprints.nottingham.ac.uk/59099/ |
| _version_ | 1848799587053076480 |
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| author | Zhao, Miaomiao Liu, Baohua Shan, Linghan Li, Cui Wu, Qunhong Hao, Yanhua Chen, Zhuo Lan, Lan Kang, Zheng Liang, Libo Ning, Ning Jiao, Mingli |
| author_facet | Zhao, Miaomiao Liu, Baohua Shan, Linghan Li, Cui Wu, Qunhong Hao, Yanhua Chen, Zhuo Lan, Lan Kang, Zheng Liang, Libo Ning, Ning Jiao, Mingli |
| author_sort | Zhao, Miaomiao |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background: Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China's health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to ieffectiveness.
Methods: A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices.
Results: Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality.
Conclusions: The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed. |
| first_indexed | 2025-11-14T20:38:02Z |
| format | Article |
| id | nottingham-59099 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T20:38:02Z |
| publishDate | 2019 |
| publisher | BMC |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-590992019-09-19T13:46:49Z https://eprints.nottingham.ac.uk/59099/ Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China Zhao, Miaomiao Liu, Baohua Shan, Linghan Li, Cui Wu, Qunhong Hao, Yanhua Chen, Zhuo Lan, Lan Kang, Zheng Liang, Libo Ning, Ning Jiao, Mingli Background: Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China's health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to ieffectiveness. Methods: A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. Results: Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. Conclusions: The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed. BMC 2019-09-10 Article PeerReviewed application/pdf en cc_by https://eprints.nottingham.ac.uk/59099/1/integration%20merged.pdf Zhao, Miaomiao, Liu, Baohua, Shan, Linghan, Li, Cui, Wu, Qunhong, Hao, Yanhua, Chen, Zhuo, Lan, Lan, Kang, Zheng, Liang, Libo, Ning, Ning and Jiao, Mingli (2019) Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China. BMC Health Services Research, 19 . 654/1-654/11. ISSN 1472-6963 medical insurance integration; inequity; inequality; inpatient service utilization http://dx.doi.org/10.1186/s12913-019-4480-8 doi:10.1186/s12913-019-4480-8 doi:10.1186/s12913-019-4480-8 |
| spellingShingle | medical insurance integration; inequity; inequality; inpatient service utilization Zhao, Miaomiao Liu, Baohua Shan, Linghan Li, Cui Wu, Qunhong Hao, Yanhua Chen, Zhuo Lan, Lan Kang, Zheng Liang, Libo Ning, Ning Jiao, Mingli Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China |
| title | Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China |
| title_full | Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China |
| title_fullStr | Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China |
| title_full_unstemmed | Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China |
| title_short | Can integration reduce inequity in healthcare utilization?: evidence and hurdles in China |
| title_sort | can integration reduce inequity in healthcare utilization?: evidence and hurdles in china |
| topic | medical insurance integration; inequity; inequality; inpatient service utilization |
| url | https://eprints.nottingham.ac.uk/59099/ https://eprints.nottingham.ac.uk/59099/ https://eprints.nottingham.ac.uk/59099/ |