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Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES

Author

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  • Jiaoling Huang

    (School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)

  • Li Yuan

    (School of Social Development and Public Policy, Fudan University, Shanghai 200433, China
    International Department, All China Youth Federation, Beijing 100051, China)

  • Hong Liang

    (School of Social Development and Public Policy, Fudan University, Shanghai 200433, China)

Abstract

Background: China has achieved universal coverage, with a higher rate of 95% medical insurance. However, huge inequalities are concealed under universal coverage. This article aims to explore the medical insurance utilization disparities over different insurance schemes, regions, and socioeconomic statuses (SES). Methods: This study was based on an open-access dataset in 2010, 2012, 2014, and 2016. A longitudinal analysis and separate logistic models were performed. Results: Urban Employee Basic Medical Insurance (UEBMI) members had an outstanding advantage in specialist visiting over those on the Urban Resident Basic Medical Insurance Scheme (URBMI) (OR = 0.607, p < 0.001) and New Cooperative Medical System (NCMS) (OR = 0.262, p < 0.001). However, in terms of a doctor visiting if a person is sick, the odds of patients in the NCMS receiving a visit were 55.1% ((OR = 1.551; p < 0.05) higher than those on the UEBMI. Compared with west China, the odds of those in the north-east and east were 2.1% ( p > 0.05) and 97.2% (OR = 1.972; p < 0.001) higher for seeking medical treatment if sick, and 10.8% (OR = 0.892; p < 0.01) and 42.7% lower (OR = 0.573; p < 0.001) for a specialist visiting. In terms of SES, for each unit of increase in the Standard International Occupational Prestige Scale (SIOPS), the odds of seeking medical treatment decreased by 4.3% (OR = 0.958; p < 0.05), and the odds of a specialist visiting increased by 17.1% (OR = 1.171; p < 0.001) for each unit of the annual income logarithm. Conclusions: NCMS members and residents in west China were in a disadvantage status in terms of access to specialists, though had a higher probability of medical care if sick. SES variables were positively correlated with a specialist visiting consistently. We suggest a further focus on healthcare quality in the west and rural areas.

Suggested Citation

  • Jiaoling Huang & Li Yuan & Hong Liang, 2020. "Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES," IJERPH, MDPI, vol. 17(11), pages 1-17, June.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:11:p:4131-:d:369455
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    References listed on IDEAS

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    1. Chen, Yuyu & Jin, Ginger Zhe, 2012. "Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China," Journal of Health Economics, Elsevier, vol. 31(1), pages 1-14.
    2. Xin Xie & Qunhong Wu & Yanhua Hao & Hui Yin & Wenqi Fu & Ning Ning & Ling Xu & Chaojie Liu & Ye Li & Zheng Kang & Changzhi He & Guoxiang Liu, 2014. "Identifying Determinants of Socioeconomic Inequality in Health Service Utilization among Patients with Chronic Non-Communicable Diseases in China," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-14, June.
    3. Yu, Hao, 2015. "Universal health insurance coverage for 1.3 billion people: What accounts for China's success?," Health Policy, Elsevier, vol. 119(9), pages 1145-1152.
    4. Chaofan Li & Lei Dou & Haipeng Wang & Shanshan Jing & Aitian Yin, 2017. "Horizontal Inequity in Health Care Utilization among the Middle-Aged and Elderly in China," IJERPH, MDPI, vol. 14(8), pages 1-13, July.
    5. Win Lin Chou & Zijun Wang, 2009. "Regional inequality in China's health care expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 137-146, July.
    6. Xiaoyan Lei & Wanchuan Lin, 2009. "The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 25-46, July.
    7. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    8. E Xie, 2011. "Income-Related Inequalities of Health and Health Care Utilization," Frontiers of Economics in China-Selected Publications from Chinese Universities, Higher Education Press, vol. 6(1), pages 131-156, March.
    9. Liu, Xingzhu & Hsiao, William C. L., 1995. "The cost escalation of social health insurance plans in China: Its implication for public policy," Social Science & Medicine, Elsevier, vol. 41(8), pages 1095-1101, October.
    10. E. Xie, 2011. "Income-related inequalities of health and health care utilization," Frontiers of Economics in China, Springer;Higher Education Press, vol. 6(1), pages 131-156, March.
    11. Liu, Hong & Zhao, Zhong, 2014. "Does health insurance matter? Evidence from China’s urban resident basic medical insurance," Journal of Comparative Economics, Elsevier, vol. 42(4), pages 1007-1020.
    12. Yip, Winnie & Hsiao, William, 2009. "China's health care reform: A tentative assessment," China Economic Review, Elsevier, vol. 20(4), pages 613-619, December.
    13. Gang Chen & Gordon Liu & Fei Xu, 2014. "The Impact of the Urban Resident Basic Medical Insurance on Health Services Utilisation in China," PharmacoEconomics, Springer, vol. 32(3), pages 277-292, March.
    14. You, Xuedan & Kobayashi, Yasuki, 2009. "The new cooperative medical scheme in China," Health Policy, Elsevier, vol. 91(1), pages 1-9, June.
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    Cited by:

    1. Lin Pan & Cong Wang & Xiaolin Cao & Huanhuan Zhu & Li Luo, 2022. "Unmet Healthcare Needs and Their Determining Factors among Unwell Migrants: A Comparative Study in Shanghai," IJERPH, MDPI, vol. 19(9), pages 1-18, May.

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