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

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اقرأ على الانترنت اقرأ أكثر حفظ في قائمتي
  • معلومة اضافية
    • المصدر:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: London : BioMed Central, [2001-
    • الموضوع:
      Chronic Disease/*trends ; Delivery of Health Care, Integrated/*statistics & numerical data ; Healthcare Disparities/*statistics & numerical data ; Hospitalization/*statistics & numerical data ; Patient Acceptance of Health Care/*statistics & numerical data; Adolescent ; Adult ; Aged ; China ; Facilities and Services Utilization ; Female ; Humans ; Income/statistics & numerical data ; Insurance, Health/statistics & numerical data ; Male ; Middle Aged ; National Health Programs/statistics & numerical data ; Rural Health/statistics & numerical data ; Socioeconomic Factors ; Surveys and Questionnaires ; Urban Health/statistics & numerical data ; Young Adult
    • نبذة مختصرة :
      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.
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    • Grant Information:
      71333003 National Natural Science Foundation of China; 71573068 National Natural Science Foundation of China
    • Contributed Indexing:
      Keywords: Inequality; Inequity; Inpatient service utilization; Medical insurance integration
    • الموضوع:
      Date Created: 20190911 Date Completed: 20191223 Latest Revision: 20231104
    • الموضوع:
      20231215
    • الرقم المعرف:
      PMC6734466
    • الرقم المعرف:
      10.1186/s12913-019-4480-8
    • الرقم المعرف:
      31500617