Lee Yen-Han, Chiang Timothy, Shelley Mack, Liu Ching-Ti
Indiana University School of Public Health , Bloomington, Indiana, USA.
Pennsylvania State University College of Medicine , Hershey, Pennsylvania, USA.
Int J Health Care Qual Assur. 2018 Aug 13;31(7):746-756. doi: 10.1108/IJHCQA-06-2017-0098.
The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China's social health insurance scheme following the reform.
DESIGN/METHODOLOGY/APPROACH: Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design ( n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported.
The authors found that education is associated with all social health insurance schemes in China after the reform ( p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44-8.13) or university and above (OR: 9.86, 95% CI: 8.14-11.96), are associated with UEBMI, compared with lower-educated individuals.
The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China's universal health coverage and social disparity.
ORIGINALITY/VALUE: This study is the first to investigate the association between residents' educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.
自20世纪后期以来，中国社会经历了快速的社会改革，包括教育和医疗体系。2009年，中国中央政府启动了一项雄心勃勃的医疗改革计划，以提高服务质量并提供可负担的医疗服务，而不论个人的社会经济地位如何。目前，中国社会医疗保险包括城镇职工基本医疗保险、城镇居民基本医疗保险和新型农村合作医疗。本文旨在衡量改革后个人教育水平与中国社会医疗保险计划之间的关联。
设计/方法/途径：使用最新的（2011年）中国健康与营养调查（CHNS）数据以及具有横断面设计的多变量逻辑回归模型（n = 11,960），报告比值比（OR）和95%置信区间（95%CI）。
作者发现，改革后教育与中国所有社会医疗保险计划相关（p < 0.001）。与受教育程度较低的个体相比，具有较高教育水平的居民，如技校学历（OR：6.64，95%CI：5.44 - 8.13）或大学及以上学历（OR：9.86，95%CI：8.14 - 11.96），与城镇职工基本医疗保险相关。
中国中央政府宣布了一项计划，到2020年将除城镇职工基本医疗保险（这是资金最全面的计划）之外的所有社会医疗保险计划合并。需要进一步研究以调查合并后的潜在差异。政策制定者应继续评估中国的全民医保覆盖情况和社会差异。
原创性/价值：本研究首次调查了2009年医疗改革后居民教育程度与三种社会医疗保险计划之间的关联。作者认为，在这项雄心勃勃的医疗改革之后，教育程度仍然与每种社会医疗保险覆盖情况相关。
