Pu Xiaohong, Hou Riyun, He Sichang, Zhang Weike
School of Public Administration, Sichuan University, Chengdu 610065, China.
The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
Healthcare (Basel). 2025 Jun 17;13(12):1455. doi: 10.3390/healthcare13121455.
Health inequality is seen as a challenge for implementing the Healthy China Strategy. This study analyzes the income-related health inequality among urban-rural resident basic medical insurance (URRBMI) participants.
This study utilized data from the 2019 China Household Finance Survey (CHFS), and the concentration index (CI) was employed to estimate the effects of income-related health inequality on participants.
Our findings provide clear evidence that health inequality among participants has fluctuated-narrowing, widening, and then narrowing again-in the areas of the contribution, medical treatment, and reimbursement of URRBMI, respectively. Overall, the analysis indicates a widening of health inequality post-reimbursement, with results remaining consistent. A heterogeneity analysis shows that health inequality is most pronounced among women and those with less than a middle school education. Finally, our study reveals a pro-rich trend in the actual utilization of medical services among participants, with persistent disparities in outpatient and inpatient service usage even after standardization, further exacerbating income-related health inequality.
We recommend that the URRBMI design take participants' income levels into account, with policies favoring disadvantaged individuals to enhance their medical security, improve access to healthcare services, and ultimately reduce health inequality.
健康不平等被视为实施健康中国战略的一项挑战。本研究分析了城乡居民基本医疗保险（URRBMI）参保人员中与收入相关的健康不平等情况。
本研究使用了2019年中国家庭金融调查（CHFS）的数据，并采用集中指数（CI）来估计与收入相关的健康不平等对参保人员的影响。
我们的研究结果提供了明确证据，表明参保人员之间的健康不平等在城乡居民基本医疗保险的缴费、就医和报销方面分别呈现出波动——先缩小、再扩大、然后又缩小的趋势。总体而言，分析表明报销后健康不平等有所扩大，结果保持一致。异质性分析表明，健康不平等在女性和初中以下文化程度人群中最为明显。最后，我们的研究揭示了参保人员在医疗服务实际利用方面存在亲富趋势，即使在标准化之后，门诊和住院服务使用方面仍存在持续差距，进一步加剧了与收入相关的健康不平等。
我们建议城乡居民基本医疗保险的设计应考虑参保人员的收入水平，制定有利于弱势群体的政策，以增强他们的医疗保障，改善获得医疗服务的机会，并最终减少健康不平等。
