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![The operation of BHIS system. Source: Based on Hsiao [12]](publication/6470380/figure/fig1/AS:202846218788867@1425373715567/The-operation-of-BHIS-system-Source-Based-on-Hsiao-12_Q320.jpg)
![NHSS sampling process. Source: Gao et al [15] and Centre for Health...](publication/6470380/figure/fig2/AS:202846218788869@1425373715593/NHSS-sampling-process-Source-Gao-et-al-15-and-Centre-for-Health-Statistics-and_Q320.jpg)
In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme (GIS) and Labour Insura...
Citations
... Even though most of the studies analyzed the change of health utilization in a short period (usually within five years) based on the data from healthcare provider [16][17][18], the data of health service demand cannot be obtained directly, and the inpatient care utilization from the provider side is usually overestimated. In addition, a few of studies analyzed the health utilization before 2013 by using the data from the National Health Service Survey (NHSS) [19,20]. However, the literature reveals a lack of studies describing a coherent, non-fragmented analysis of China's health care utilization and equality from 1993 to 2018 covering a series of health reforms based on the data from demanding side. ...
... Details of the interview procedures have been reported previously [20][21][22]. Briefly, well-trained household interview staff did the face-to-face interview based on a structured questionnaire. ...
... Fifth, when the scheduled household was unavailable after three attempts to conduct the survey, a household in the waiting list was selected and the completion rate of the interviews should be more than 95%. Last, double data entry has been used since 2003 [20,21]. ...
Background:
Changes in China's health care system in the last three decades was remarkable. The current study aims on examine the change of equality of health care utilization in mainland China based on a nationwide household interview survey.
Methods:
We used household interview data extracted from six waves of National Health Service Survey between 1993 and 2018. Changes of health care utilization were descripted. Equality of the utilization were examined with univariate meta-regression across urban and rural areas, socioeconomic development regions and income groups.
Results:
The proportion of outpatient visits within last two weeks experienced a decrease from 17.0% in 1993 to 13.0% in 2013 and bounced back to 24.0% in 2018. The age-standardized trend remained unchanged. Hospitalization in the last 12 month increased from 2.6% in 1998 to 13.8% in 2018. The perceived unmet need of hospital admission fell from 35.9% in 1998 to 21.5% in 2018. The gaps in health care utilization between urban and rural areas, across regions and by income groups have been narrowed, implying improved equality of using medical services in the last two and a half decades.
Conclusion:
China has experienced significant increases in health care utilization over the past 25 years. Meanwhile, the unmet needs for health care decreased remarkably and the equality of health care utilization improved significantly. These results imply significant achievements in health service accessibility in China.
... For example, the hierarchical diagnosis and treatment system has been established, and the universal medical insurance system has been improved [6,7]. These changes have brought many benefits, including levels of improvement in medical services and expenditure burden reductions in medical treatments [8,9]. As of 2020, China's MHS encompassed 35,394 hospitals, 970,036 primary medical and health institutions, and 14,492 professional public health institutions [10]. ...
Background
Equity and efficiency are basic value dimensions to evaluate the effectiveness of China’s medical and health service system (MHS) reform and development. Coordinated development of equity and efficiency is necessary to realize high-quality development of medical and health services. This study aims to evaluate the equity, efficiency, and combined efforts in coordinating the MHS during 1991–2020 reform.
Methods
Data on China’s MHS were obtained from the China Statistical Yearbook 1992–2021. Ratios of urban to rural residents’ medical expenditure and number of medical professionals per 10,000 people were employed to evaluate MHS’s equity. The data envelopment analysis-Malmquist model was employed to evaluate MHS’s efficiency. We constructed a combined-efforts-in-coordination model to examine the coordination degree between equity and efficiency.
Results
Equity of medical expenditure burden significantly improved from during 1991–2007. Urban residents’ 1991 medical expenditure burden was 87.8% of that of rural residents, which increased to 100.1% in 2007. Urban areas’ mean medical expenditure burden was 105.94% of that in rural areas during 1991–2007. The gap in equity of medical expenditure burden between urban and rural areas slowly widened after 2007, with urban areas’ mean burden being 68.52% of that in rural areas during 2007–2020. Medical and health resources allocation shows an alarming inequity during this period, with mean number of medical professionals per 10,000 people in urban areas being 238.30% of that in rural areas. Efficiency experienced several fluctuations before 2008. Since 2008, efficiency was high (0.915) and remained stable, except in 2020. The combined-efforts-in-coordination score for medical expenditure burden was less than 0.2 for 80% of the years, while that for in medical and health resources was more than 0.5 for 99.67% of the years.
Conclusions
MHS inequity remains between urban and rural China, primarily because of disproportionate allocation of medical and health resources. The government should enhance rural medical professionals’ salary and welfare and provide medical subsidies for rural residents to adjust resource allocation levels in urban and rural areas, control differences in medical expenditure burden between urban and rural residents to a reasonable range, and continuously improve urban and rural residents’ equity level.
... While NCMS and URBMI cover most residents in rural and residents without a job in urban, UEBMI aims to provide health insurance to employed urban residents. Based on the pilot reforms in the cities of Zhenjiang and Jiujiang, UEBMI was proposed to replace the government insurance scheme and the labor insurance scheme [55,56]. In general, UEBMI stipulates that the employment-based basic health insurance scheme should cover urban employees, including workers from both public and private enterprises. ...
Background
Many internal migrants during the urbanization process in China are Migrant Parents, the aging group who move to urban areas to support their family involuntarily. They are more vulnerable economically and physically than the younger migrants. However, the fragmentation of rural and urban health insurance schemes divided by “hukou” household registration system limit migrant’s access to healthcare services in their resident location. Some counties have started to consolidate the Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NRCMS) as one Integrated Medical Insurance Schemes (IMIS) from 2008. The consolidation aimed to reduce the disparity between different schemes and increase the health care utilization of migrants.
Results
Using the inpatient sample of migrant parents from China Migrants Dynamic Survey in 2015, we used Ordinary Least Squares (OLS) for regression models. We found that the migrant parents covered by the IMIS are more likely to choose inpatient services and seek medical treatment in the migrant destination. We further subdivide Non-IMISs into NCMSs and URBMIs in the regression to alleviate the doubt about endogenous. The results revealed that the migrant parents in IMIS use more local medical services than both of them in URBMI and NCMS.
Conclusions
The potential mechanisms of our results could be that IMIS alleviates the difficulty of seeking medical care in migrant destinations by improving the convenience of medical expense reimbursement and enhancing health insurance benefits.
... According to the 2008 National Health Service Survey, the estimated direct medical cost of diabetes was approximately $8.65 billion. 6 In 2009-2010, Yang et al 7 interviewed 1,482 adults with diabetes at 12 different locations in China to evaluate the medical care and costs for diabetes. They found that annual cost for medications from all sources reached ¥1,573 ($243) per person. ...
Purpose:
Although the cost and complexity of managing diabetes is increasing around the world, placing greater burden on patients and their families, the cost of drug regimens prescribed to Chinese patients has not been evaluated. This study was conducted to evaluate the temporal changes in the costs and drugs used for people with diabetes.
Methods:
Patients enrolled in Beijing Medical Insurance with outpatient medical records from 2016 through 2018 were included in this study. The outcomes of interest were: (1) the number of outpatient medications, (2) the number of comorbidities diagnosed, (3) the estimated annual cost of the outpatient drug regimen, (4) the drug therapy strategies used for diabetic patients, and (5) the most commonly prescribed classes of drugs.
Results:
Over the 3-year period, there was a significant decrease (9.0%, P <.001) in the average number of diabetes medications used. Both antiglycemic and non-antiglycemic drug use decreased by 3.6% and 12.9%, respectively. Similarly, for estimated annual costs of medication, an 18.4% (P <.05) decrease was observed, with a gradual decreased from ¥6,868 ($1,059) in 2016 to ¥5,605 ($865) in 2018.
Conclusion:
This is the first large-scale cost analysis of the medical management of diabetes since the implementation of medical insurance in China. Despite the increasing availability of newer, more expensive diabetes drugs, there was a significant reduction in the number of diabetes medications used, that may be due to a more rational approach to optimizing metabolic targets.
... Since 1993, the National Health Commission conducted national health services survey every five years. The national health services survey collected information on health needs and service utilization using a repeated cross-sectional study design [9,10]. Indicators for geographic access to the nearest health facilities, patients needing but not using inpatient services, and patients' satisfaction with outpatient and inpatient services were extracted from the national health service survey reports from 2003 to 2018. ...
Background:
This paper aims to develop a Chinese version of Universal Health Coverage (UHC) indices and to measure China's progress towards UHC.
Methods:
Nineteen indicators were selected based on expert consultations to construct indices of accessibility and affordability to measure UHC. Data were drawn from health statistics yearbooks, nationally representative surveys, and health system reform surveillance. The index of accessibility includes absolute accessibility (to essential health services), relative accessibility (to hospital care) and people's subjective perceptions. The index of affordability includes absolute affordability (the incidence of catastrophic health expenditure, CHE), relative affordability (the composition of health expenditure), and people's subjective perceptions.
Results:
The indices of accessibility and affordability both showed steady increases over the 17 years considered. Absolute accessibility had the most significant improvement (from 23.6 in 2002 to 73.8 in 2018), while the index of relative accessibility decreased from 81.4 in 2002 to 67.3 in 2018. The index of absolute affordability decreased significantly from 46.6 in 2002 to 30.5 in 2010 and then exhibited an increasing trend afterwards, reaching 52.1 in 2018. The index of relative affordability continuously increased during the observation period, from 35.3 to 75.4.
Conclusions:
China has made great progress in increasing the accessibility and affordability of health services since the health system reforms in 2009. However, integrating primary health care and hospital care and containing escalating medical expenditure to further reduce patients' financial burdens are key challenges for strengthening the Chinese health system.
... The Chinese government has been trying to build a universal public social health insurance (SHI) system since the early 2000s, and has essentially achieved universal SHI coverage [1][2][3][4]. The ambitious SHI initiative consists of three key programs: the Urban Employee Basic Medical Insurance (UEBMI) for the urban employed, initiated in 1998; the New Cooperative Medical Scheme (NCMS) for rural residents, established in 2003; and the Urban Resident Basic Medical Insurance (URBMI), covering urban residents without formal employment (including children, the elderly, and other unemployed), launched in 2007. ...
Background
China initiated a reform of the health insurance system in the late 1990s. The new insurance, Urban Employee Basic Medical Insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance.
Methods
Based on three large sample of micro datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a logistic regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups.
Results
Based on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of UEBMI between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more significant in the low-education group, while no gender differences were found in the high-education group.
Conclusions
This paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women’s greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI’s implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.
... As shown in Table 1, approximately 50% of urban residents were left without effective social health insurance coverage in the late 1990s. 24 Even for those covered by UEBMI, their health insurance benefits were less generous. 25 China's health delivery system also went through dramatic reforms from a centrally-planned system to a heavily market-based one. ...
From 1986 to 2009, China’s health system reform first adopted a market-oriented approach and later reemphasized the role of the government starting from 2002. China’s oscillating health care financing policies present us a unique opportunity to examine the consequences of government-led financing and market-oriented financing measures. This study uses the Urban Household Survey, a diary data in China that covers the period of 1986 to 2009, to examine the long-run trends in the incidence and intensity of catastrophic health expenditure and medical impoverishment. Four major findings emerge. First, the incidence and intensity of catastrophic health expenditure in urban Chinese households increased rapidly between 1986 and 2002, whereas they stabilized after 2002. Second, the incidence of medical impoverishment and its depth in the poverty gap remained stable before 2002 and decreased rapidly after 2002. Third, income and regional inequality in measures of catastrophic health expenditure widened from 1986 to 2002. They narrowed in the 2000s but remain wide. Fourth, income and regional inequality in medical impoverishment remained unchanged between 1986 and 2002 and narrowed substantially after 2002. All these results suggest that China’s two cycles of health care reform generated significantly different outcomes in financial protection, holding lessons for the ongoing health care reform in China and other countries.
... 40,41 People who infected HBV might die from AHB or chronic HBV infection, cirrhosis, and HCC. 32,48 Age-specific mortality rate was derived from Beijing 1% population sample survey report in 2015. 42 (Appendix) ...
Objectives:
To evaluate cost-utility of universal Hepatitis B vaccination program in the Beijing city (Beijing).
Methods:
A decision-Markov model was constructed to determine the cost-utility of the universal immunization program for infants (universal vaccination program) by comparing with a hypothetic nonvaccination strategy in Beijing. Parameters in models were extracted from Beijing Center for Disease Control and Prevention (CDC) annual work report, Beijing health statistical yearbook, National Health Survey report, Beijing 1% population sample survey report, Beijing Health and Medical Price Monitoring Data Platform, and public literatures. The incremental cost‑utility ratio (ICUR) was used to compare alternative scenarios. One-way sensitivity analysis and probabilistic sensitivity analysis were used to assess parameter uncertainties.
Results:
The universal vaccination program had increased the utility and reduced cost among infants born in 2016 in Beijing. The ICUR was CNY -24,576.61 (US$ -3779.16) per QALY for universal vaccination program comparing with non-vaccination scenario from healthcare perspective. It was estimated that the universal vaccination would save direct medical treatment cost of CNY 2,262,869,173.50 (US$ 347,962,414.43) and prevent loss of 18322.25 QALYs within lifetime of target cohort. Discount rate accounted for the most remarkable influence on ICUR in one-way sensitivity analysis. The result of probabilistic sensitivity analysis illustrated that all of the ICURs were located in the fourth quadrant of the cost-utility incremental plot undergone 5000 times of Monte Carlo simulation.
Conclusions:
Current universal hepatitis B vaccination program in Beijing was highly cost utility. The investment was reasonable for current universal vaccination program in Beijing.
... 24,25 Whether China's recent progress towards universal health insurance has positively influenced such observations is not clear. 26 Previous studies have shown a correlation between the number of years of education and the clinical outcomes in CHD patients. 12,26−29 The current study also showed less educated patients were at higher risk for adverse clinical events, and this is fully explained by differences in age, sex, and presentation with more clinically severe disease. ...
Background
Previous studies have shown an inverse relationship between education and clinical outcomes in coronary heart disease. Whether a similar association exists in patients presenting with suspected acute coronary syndromes (ACS) in China is unknown.
Methods
Clinical Pathways for Acute Coronary Syndromes – Phase 2 (CPACS-2) was a study to evaluate a quality improvement for ACS management in China which implemented in 75 hospitals between October 2007 and August 2010. All patients was divided into 6 groups by education level. We evaluated clinical managements and outcomes according to level of education.
Results
A total of 14350 patients were enrolled in current analysis. Patients with less education were older, had greater female representation and had a higher Killip class at admission. Compared to patients with lower education levels, more educated patients had a longer length of hospitalization (p for trend <0.001), greater likelihood of receiving appropriate coronary angiography (p for trend <0.001) and appropriate reperfusion therapy for ST-segment elevated myocardial infarction (STEMI) (p for trend <0.001) even after adjustment for differences in patient characteristics and comorbidities at presentation. Patients with less education were at higher risk of death, cardiac death and major adverse cardiovascular events but none of these differences remained statistically significant after adjustment for baseline characteristics.
Conclusion
In China, less educated patients with ACS were less likely to receive appropriate coronary angiography and reperfusion therapy. Less educated patients were at higher risk for adverse clinical events; however this was explained by differences in baseline characteristics.
... The Chinese government has been trying to build a universal public social health insurance (SHI) system since the early 2000s, and has essentially achieved universal SHI coverage [1][2][3][4] While enrollment under the UEBMI is compulsory for urban employees, the NCMS and the URBMI are voluntary insurance programs. By 2018, more than 97% of the entire Chinese population had SHI [5]. ...
Background: China initiated a reform of the health insurance system in the late 1990s. The new insurance, urban Employee basic medical insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance.
Methods: based on three large sample of micro datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a logistic regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups.
Results: Based on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of UEBMI between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more significant in the low-education group, while no gender differences were found in the high-education group.
Conclusions: This paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women’s greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI’s implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.
