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. 2017 Nov 10;12(11):e0187100.
doi: 10.1371/journal.pone.0187100. eCollection 2017.

Differences exist across insurance schemes in China post-consolidation

Yang Li  1   2   3 , Yinjun Zhao  4 , Danhui Yi  1   2   3 , Xiaojun Wang  1 , Yan Jiang  1 , Yu Wang  1 , Xinchun Liu  4 , Shuangge Ma  1   4
Affiliations

Differences exist across insurance schemes in China post-consolidation

Yang Li et al. PLoS One. .

Abstract

Background: In China, the basic insurance system consists of three schemes: the UEBMI (Urban Employee Basic Medical Insurance), URBMI (Urban Resident Basic Medical Insurance), and NCMS (New Cooperative Medical Scheme), across which significant differences have been observed. Since 2009, the central government has been experimenting with consolidating these schemes in selected areas. This study examines whether differences still exist across schemes after the consolidation.

Methods: A survey was conducted in the city of Suzhou, collecting data on subjects 45 years old and above with at least one inpatient or outpatient treatment during a period of twelve months. Analysis on 583 subjects was performed comparing subjects' characteristics across insurance schemes. A resampling-based method was applied to compute the predicted gross medical cost, OOP (out-of-pocket) cost, and insurance reimbursement rate.

Results: Subjects under different insurance schemes differ in multiple aspects. For inpatient treatments, subjects under the URBMI have the highest observed and predicted gross and OOP costs, while those under the UEBMI have the lowest. For outpatient treatments, subjects under the UEBMI and URBMI have comparable costs, while those under the NCMS have much lower costs. Subjects under the NCMS also have a much lower reimbursement rate.

Conclusions: Differences still exist across schemes in medical costs and insurance reimbursement rate post-consolidation. Further investigations are needed to identify the causes, and interventions are needed to eliminate such differences.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Reasons for not using insurance for outpatient treatment.
Fig 2
Fig 2. Density of predicted gross and OOP cost (1k RMB) for inpatient and outpatient treatments.
Top left: Gross cost for inpatient treatment. Top right: OOP cost for inpatient treatment. Bottom left: Gross cost for outpatient treatment. Bottom right: OOP cost for outpatient treatment.
Fig 3
Fig 3. Density of predicted reimbursement rate.
Left: Inpatient. Right: Outpatient.
See this image and copyright information in PMC

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