城乡居民基本医疗保险整合对卫生服务公平性的影响：来自中国的证据。

The impact of integrated urban and rural resident basic medical insurance on health service equity: Evidence from China.

机构信息

Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.

出版信息

Front Public Health. 2023 Mar 13;11:1106166. doi: 10.3389/fpubh.2023.1106166. eCollection 2023.

DOI:10.3389/fpubh.2023.1106166

PMID:36992886

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10040545/

Abstract

BACKGROUND

Many countries and regions worldwide are improving their healthcare systems through the integration and unification of health insurance programs covering different groups of people. In China, the past 10 years has been the time when Chinese government promote the Urban and Rural Residents Basic Medical Insurance (URRBMI) by integrating the Urban Residents' Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS).

OBJECTIVES

To evaluate the impact of the URRBMI on equity in relation to health services.

METHODS

The quantitative data used in this study were obtained from the CFPS 2014-2020 database, and all respondents with health insurance type UEBMI, URBMI, and NRCMS were included. UEBMI respondents were set as the control group and URBMI or NRCMS as the intervention group, and a DID method model was used to analyze the impact of integrating health insurance on health service utilization, costs and health status. Heterogeneity analysis was also conducted after stratifying the sample according to income level and chronic disease status. This was done to investigate whether there were differences in the effects of the integrated health insurance program across different social groups.

RESULTS

The implementation of URRBMI is found to be associated with a significant increase in inpatient service utilization (OR = 1.51, < 0.01) among rural Chinese residents. Regression results by income stratum show that the utilization of inpatient services increased in rural areas for high-, middle- and low-income groups, with the fastest increase (OR = 1.78, < 0.05) emerging for low-income groups. Analysis by chronic disease status shows that rural residents with chronic disease are associated with a higher increase in hospitalization rates (OR = 1.64, < 0.01).

CONCLUSION

The implementation of URRBMI is found to have improved health insurance's ability to withstand risks and effectively improve access to health services for rural residents. In this regard, it can be considered as playing a positive role in bridging the gap in health service utilization between rural and urban areas and in improving regional equity.

摘要

背景

全球许多国家和地区正在通过整合和统一涵盖不同人群的健康保险计划来改善其医疗体系。在中国，过去 10 年是政府通过整合城镇居民基本医疗保险（URBMI）和新型农村合作医疗制度（NRCMS）来推广城乡居民基本医疗保险（URRBMI）的时期。

目的

评估 URRBMI 对健康服务公平性的影响。

方法

本研究使用的定量数据来自 CFPS 2014-2020 数据库，包括所有有 UEBMI、URBMI 和 NRCMS 保险类型的受访者。UEBMI 受访者被设为对照组，URBMI 或 NRCMS 为干预组，采用 DID 方法模型分析整合医疗保险对卫生服务利用、成本和健康状况的影响。还根据收入水平和慢性病状况对样本进行分层后进行了异质性分析，以调查综合健康保险计划在不同社会群体中的效果是否存在差异。

结果

URRBMI 的实施与中国农村居民住院服务利用率的显著增加（OR=1.51， <0.01）相关。按收入阶层回归结果显示，农村地区高、中、低收入群体的住院服务利用率均有所增加，其中低收入群体的增长最快（OR=1.78， <0.05）。按慢性病状况分析表明，农村慢性病患者的住院率增加幅度更高（OR=1.64， <0.01）。