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Comparative Study
. 2019 Sep 10;19(1):654.
doi: 10.1186/s12913-019-4480-8.

Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China

Miaomiao Zhao  1   2 , Baohua Liu  1 , Linghan Shan  1 , Cui Li  1 , Qunhong Wu  3 , Yanhua Hao  4 , Zhuo Chen  5   6 , Lan Lan  1 , Zheng Kang  1 , Libo Liang  1 , Ning Ning  1 , Mingli Jiao  1
Affiliations
Comparative Study

Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China

Miaomiao Zhao et al. BMC Health Serv Res. .

Abstract

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 its ineffectiveness.

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.

Keywords: Inequality; Inequity; Inpatient service utilization; Medical insurance integration.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of inpatient service utilization across household income quintiles
Fig. 2
Fig. 2
Non-admission rates across household income quintiles
See this image and copyright information in PMC

References

    1. Stronks K, Louise GJ. Should equity in health be target number 1? Eur J Pub Health. 1993;3(2):104–111. doi: 10.1093/eurpub/3.2.104. - DOI
    1. Murray CJL, Frenk J. A framework for assessing performance of health system. Bull World Health Organ. 2000;78:717–731. - PMC - PubMed
    1. Ottersen T, Norheim OF. Chitah BM, Cookson R, Daniels N, Defaye FB, Eyal N, Flores W, Gosseries A, Hausman D, et al. Making fair choices on the path to universal health coverage. Bull World Health Organ. 2014;92:389. doi: 10.2471/BLT.14.139139. - DOI - PMC - PubMed
    1. de Looper M, Lafortune G. "Measuring Disparities in Health Status and in Access and Use of Health Care in OECD Countries", OECD Health Working Papers, No. 43. Paris: OECD Publishing; 2009. 10.1787/225748084267.
    1. McIntyre D, Ranson MK, Aulakh BK, Honda A. Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress. Health Res Policy Syst. 2013;11:36. doi: 10.1186/1478-4505-11-36. - DOI - PMC - PubMed

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