School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China.
School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
Value Health. 2022 Sep;25(9):1548-1558. doi: 10.1016/j.jval.2022.03.007. Epub 2022 May 3.
The reform of merging 2 major health insurance schemes into Urban and Rural Resident Basic Medical Insurance (URRBMI) is recognized as a vital step to safeguard equal healthcare and benefit to each enrollee in China. Against this backdrop, this article aims to evaluate the impact of URRBMI integration on benefit and its contribution to benefit equity.
The data of this study were derived from the China Health and Retirement Longitudinal Study 2011 and 2015. A total of 11 383 individuals were included in the final sample. Coarsened exact matching with difference-in-difference approach was firstly adopted to investigate the treatment effects of URRBMI on benefits. Next, the decomposition of concentration index (CI) was conducted to explore the contribution of URRBMI to benefit equity.
The coarsened exact matching with difference-in-difference results revealed that the consolidation of URRBMI has significantly improved outpatient benefit. The decomposition results showed that the contribution rates of URRBMI scheme to outpatient benefit rate (CI -0.0114), benefit probability (CI 0.0673), compensation fee (CI 0.0076), and reimbursement ratio (CI 0.0483) were 11.26%, -3.38%, -7.67%, and -0.81%, suggesting that this reform makes contribution to the propoor inequity in the outpatient benefit rate and relieves the prorich inequity in outpatient benefit probability and the degree of benefits.
The findings of this study provide novel evidence of enhanced benefits and benefit equity for outpatient care with the integration of URRBMI. Further efforts should be made to the expansion of URRBMI coverage and the elimination of income disparities that affecting benefit equity.
将两种主要医疗保险合并为城乡居民基本医疗保险（URRBMI）的改革，被认为是保障中国每个参保人平等医疗保健和受益的重要步骤。在此背景下，本文旨在评估 URRBMI 整合对受益的影响及其对受益公平性的贡献。
本研究的数据来自中国健康与养老追踪调查 2011 年和 2015 年的数据。共有 11383 人纳入最终样本。采用粗化精确匹配差分法（Coarsened exact matching with difference-in-difference approach）首先考察 URRBMI 对受益的治疗效果。接下来，采用集中指数（CI）分解法（Decomposition of concentration index）探讨 URRBMI 对受益公平性的贡献。
粗化精确匹配差分结果显示，URRBMI 的整合显著提高了门诊受益。分解结果表明，URRBMI 方案对门诊受益率（CI-0.0114）、受益概率（CI 0.0673）、补偿费用（CI 0.0076）和报销比例（CI 0.0483）的贡献率分别为 11.26%、-3.38%、-7.67%和-0.81%，表明这一改革对门诊受益率的贫困人口不公平和门诊受益概率以及受益程度的富裕人口不公平有所缓解。
本研究结果为 URRBMI 整合提高门诊受益和受益公平性提供了新的证据。应进一步努力扩大 URRBMI 的覆盖范围，并消除影响受益公平性的收入差距。
