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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

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

Authors: Miaomiao Zhao, Baohua Liu, Linghan Shan, Cui Li, Qunhong Wu, Yanhua Hao, Zhuo Chen, Lan Lan, Zheng Kang, Libo Liang, Ning Ning, Mingli Jiao

Published in: BMC Health Services Research | Issue 1/2019

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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.
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Metadata
Title
Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China
Authors
Miaomiao Zhao
Baohua Liu
Linghan Shan
Cui Li
Qunhong Wu
Yanhua Hao
Zhuo Chen
Lan Lan
Zheng Kang
Libo Liang
Ning Ning
Mingli Jiao
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4480-8

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