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. 2025 Apr 22;15(1):13936.
doi: 10.1038/s41598-025-96922-7.

Analysis the status and spatio-temporal characteristics of the synergistic development of China's multi-level medical insurance system

Zenghui Qiu  1 , Meiling Fu  1 , Lanfang Liu  2 , Lan Yao  3 , Shanshan Yin  1 , Wen Chen  1 , Jingjing Huang  1 , Jiahui Jin  1
Affiliations

Analysis the status and spatio-temporal characteristics of the synergistic development of China's multi-level medical insurance system

Zenghui Qiu et al. Sci Rep. .

Abstract

Examined the synergistic development and spatio-temporal evolution of China's multi-level medical insurance system (MMIS) on a macroscopic level. We assess the comprehensive development of the MMIS across China's 31 provinces from 2011 to 2020 by constructing a comprehensive indicators evaluation model. Subsequently, a coupling coordination index (CCI) model is employed to provide precise insights into the coupling coordination effects among various medical insurance schemes comprising MMIS. Lastly, spatial autocorrelation analysis is conducted to evaluate both the global and local spatio-temporal evolutionary characteristics of MMIS. The CCI of MMIS at the national average level exhibited a fluctuating upward trend, progressing from the moderate disorder recession degree (0.287) in 2011 to the well-coordinated degree (0.887) in 2020. However, the majority of provinces (83.87%) still lingered within the realm of barely coordinated degree ([0.500-0.600]). Specifically, the CCI within the eastern coastal region surpassed that of the western and central regions, with the central region showing the most pronounced increase in CCI. Over the past decade, MMIS demonstrated significant spatial agglomeration, as evidenced by the global Moran's I ranging from [0.1668-0.3037]. Furthermore, findings from local spatial autocorrelation analysis suggest a gradual attenuation in the spatial clustering disparity of CCI across various provinces. Government ought to focus on the spatio-temporal evolution patterns of MMIS, and strengthen cooperation between the government and market in health governance, while utilizing information technology and data sharing to improve the overall quality of medical insurance benefits.

Keywords: Coupling coordination index; Health financing; Health governance; Multi-level medical insurance system; Spatio-temporal evolution characteristics; Universal health coverage.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Availability of data and materials: The data that support the findings of this study are openly available in China Statistical Yearbook, China Health Statistical Yearbook, China Medical Security Statistical Yearbook, China Civil Affairs Statistical Yearbook and https://www.cbirc.gov.cn/cn/view/pages/tongjishuju/tongjishuju.html .

Figures

Fig. 1
Fig. 1
Components and structure of multi-level medical insurance system in China.
Fig. 2
Fig. 2
The change of three indexes in the average level of China.
Fig. 3
Fig. 3
Spatial distribution evolution of CCI of MMIS in China. Note: Figures (a), (b), (c), and (d) depict the spatial distribution evolution of CCI of MMIS in China for the years 2011, 2014, 2017, and 2020 respectively.
Fig. 4
Fig. 4
Moran’s I scatter diagram of CCI of MMIS in China. Note: Figures (a), (b), (c), and (d) depict the scatter diagrams illustrating China’s Moran I for the years 2011, 2014, 2017, and 2020 respectively.
See this image and copyright information in PMC

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References

    1. Yip, W. et al. Universal health coverage in China part 2: Addressing challenges and recommendations. The Lancet. Public Health8(12), e1035–e1042. 10.1016/S2468-2667(23)00255-4 (2023). - PubMed
    1. Kutzin, J. Health financing for universal coverage and health system performance: Concepts and implications for policy. Bull. World Health Organ.91(8), 602–611. 10.2471/BLT.12.113985 (2013). - PMC - PubMed
    1. Odipo, E. et al. The path to universal health coverage in five African and Asian countries: Examining the association between insurance status and health-care use. Lancet Glob. Health12(1), e123–e133. 10.1016/S2214-109X(23)00510-7 (2024). - PMC - PubMed
    1. Meng, Q., Fang, H., Liu, X., Yuan, B. & Xu, J. Consolidating the social health insurance schemes in China: Towards an equitable and efficient health system. Lancet386(10002), 1484–1492. 10.1016/S0140-6736(15)00342-6 (2015). - PubMed
    1. Zhang, T. et al. What has affected the governance effect of the whole population coverage of medical insurance in China in the past decade? Lessons for other countries. Front. Public Health11, 1079173. 10.3389/fpubh.2023.1079173 (2023). - PMC - PubMed