School of Public Administration, Hunan University, Lushan Road (S), Yuelu District, Changsha, 410082, China.
Int J Equity Health. 2023 May 17;22(1):96. doi: 10.1186/s12939-023-01913-7.
Enhancing health intervention for floating populations has become an essential aspect of public health around the world. China launched a policy reform aimed at implementing immediate reimbursement for trans-provincial inpatient treatments. The objective of this study was to investigate the effects of this policy change on socioeconomic inequality in health among the floating population.
This study used two waves of individual-level data from the China Migrants Dynamic Survey (CMDS) collected in 2017 and 2018 as well as administrative hospital data at the city level. The sample included 122061 individuals and 262 cities. Under a quasi-experimental research design, we built up the framework to employ the generalized and multi-period difference-in-differences estimation strategy. We used the number of qualified hospitals that could provide immediate reimbursement to represent the degree and intensity of the implementation of this policy change. We also calculated the Wagstaff Index (WI) to measure socioeconomic inequality in health.
This policy change and income level had a negative joint impact on the health status of floating population (odds ratio = 0.955, P < 0.01), that is, the lower the income, the better the number of qualified hospitals' effect on health improvement. Furthermore, as the number of qualified tertiary hospitals increased, the health inequality would decrease significantly on average at the city level (P < 0.05). In addition, inpatient utilization as well as total expenditure and reimbursement significantly improved after the policy change, and the magnitude of increase was greater in the relatively lower-income group (P < 0.01). Finally, only inpatient spending could obtain immediate reimbursement in the early stage, thus, compared with primary care, these impacts were greater in tertiary care.
Our study revealed that after the implementation of immediate reimbursement, the floating population could obtain greater and more timely reimbursement, which significantly increased its inpatient utilization, promoted health, and reduced the health inequality caused by socioeconomic factors. These results suggest that a more accessible and friendly medical insurance scheme should be promoted for this group.
加强流动人口的健康干预已成为全球公共卫生的重要内容。中国出台了一项政策改革，旨在实现跨省住院治疗即时报销。本研究旨在调查这一政策变化对流动人口健康的社会经济不平等的影响。
本研究使用了 2017 年和 2018 年两次中国流动人口动态调查（CMDS）的个人层面数据以及城市层面的行政医院数据。样本包括 122061 人和 262 个城市。采用准实验研究设计，我们建立了框架，采用广义多期差分差异估计策略。我们用能够提供即时报销的合格医院数量来表示这一政策变化的程度和强度。我们还计算了 Wagstaff 指数（WI）来衡量健康的社会经济不平等。
这一政策变化和收入水平对流动人口的健康状况产生了负向的联合影响（比值比=0.955，P<0.01），即收入越低，合格医院数量对健康改善的效果越好。此外，随着合格三级医院数量的增加，城市层面的健康不平等程度平均显著下降（P<0.05）。此外，政策变化后，住院利用以及总支出和报销均显著增加，而低收入组的增加幅度更大（P<0.01）。最后，只有住院费用可以在早期获得即时报销，因此与初级保健相比，这些影响在三级保健中更大。
本研究表明，即时报销实施后，流动人口能够获得更大、更及时的报销，这显著增加了其住院利用，促进了健康，并减少了社会经济因素导致的健康不平等。这些结果表明，应向这一群体推广更易获得和更友好的医疗保险计划。
